Symptom outcome after craniovertebral decompression for Chiari type 1 malformation without syringomyelia

“Motion-specific Headache”: A Predictor for Diagnosis and Favorable Prognosis after Surgery in Young Patients with Chiari Malformation Type 1

“… 14) On the other hand, Pepper et al reported that the postoperative improvement rates of Valsalva-induced headache and non-specific headache were 74% and 45%, respectively. 11) In our patients, “motion-specific headache” completely disappeared after surgery, despite a reduced tension-type headache persisting. Therefore, we believe that the former type of headache can be healed by surgery in CM1 patients.…”

“… 6 – 8) The International Headache Society classification (third edition) has included CM1-specific headache and issued detailed diagnostic criteria as follows: “Headache caused by CM1, usually occipital or suboccipital, of short duration (<5 min) and provoked by cough or other Valsalva-like manoeuvres.” 9) Although headache is a common symptom and CM1 patients often show other types of headaches such as migraine and tension-type headaches, it is important to distinguish between CM1-specific and other types of headaches because of the possible favorable outcomes of surgical treatment. 10 , 11) Although this type of headache is typically induced by the difference of pressure gradients, created between the intracranial space and spinal canal by a Valsalva-like maneuver, here we report on six CM1 patients with a unique headache induced by specific movements, which are not Valsalva-like maneuvers. We have termed this headache as “motion-specific headache” and herein provide its characteristics and the surgical treatment followed in these patients.…”

Syringomyelia: diagnosis and management

“…The same operation can effectively relieve the pressure-dissociation headaches of uncomplicated Chiari malformations, although the response of other symptoms is less predictable. 16 Conduits, permitting normal CSF movement to occur, can also be created to collapse post-traumatic syrinxes, provided the arachnoid fibrosis is well localised. Post-infective scar tissue, particularly post-tuberculous adhesions, tends to be more extensive and less amenable to this approach.…”

“…Otherwise, their underlying mechanism is often unclear and yet most cease after decompression surgery. 16 Obstetric aspects of syringomyelia and Chiari form an important topic, over which views have recently changed. 21 Normal vaginal delivery is unlikely to…”

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

“…Cerebellar tonsil ectopia may interfere with the normal cranio-spinal movement of the CSF, causing increased headache in these individuals with laughing, coughing or tilting the head, or the valsalva maneuver. Also, tonsillar compression on the brain stem and upper cervical spinal cord can cause varying degrees of somatosensory disorders and subtle motor defects, as well as bulbar and lower cranial nerve disorders ( 4 ). Various theories have been proposed for CM1-related headache, some of which are; The Oldfield's theory describes pulsatile caudal pressure that occurs with mechanical contact on the spinal cord ( 5 ), William's theory describes that increased abdominal pressure occurs as a result of a craniocaudal pressure gradient that cannot diffuse into the subarachnoid space.…”