Chiari malformation-related headache: outcome after surgical treatment

Abstract

The outcome of headache in a series of 135 operated CM1 is presented. Favorable results were obtained in 85% of atypical and 93% typical headache with the support of a multidisciplinary approach that restricted the indications for surgery.

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

“…50,51 Additionally, surgical intervention possesses the highest likelihood of improving headache and ataxia, however, nausea or non-specific symptoms may persist after the intervention. 48,52 A large syrinx may also be a reason for intervention, although the absence of clinical manifestation or the lack of syrinx enlargement on imaging studies may justify conservative management. Spontaneous resolution of CMI in adults has also been documented on serial MRI imaging, although this event usually occurs in children.…”

“…Presentation with cough headache was repeatedly associated with a decreased chance of associated symptom improvement, whereas headaches of other types were identified as positive predictors for recovery in the absence of surgery 50,51 . Additionally, surgical intervention possesses the highest likelihood of improving headache and ataxia, however, nausea or non‐specific symptoms may persist after the intervention 48,52 . A large syrinx may also be a reason for intervention, although the absence of clinical manifestation or the lack of syrinx enlargement on imaging studies may justify conservative management.…”

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

“…The following criteria were used to diagnose CM1: 1) ≥5 mm caudal descent of the cerebellar tonsils or 2) ≥3 mm caudal descent of the cerebellar tonsils plus ≥1 indicator of crowding of the subarachnoid space in the area of the craniocervical junction. [1][2][3][4][5][6][7][8][9] The selected patients underwent foramen magnum decompression (FMD) through a 2.5 × 2.5 cm craniotomy, and then underwent additional surgical procedures such as removal of the posterior C1 arch, duraplasty, removal of the outer dura layer, and tonsil resection. These additional procedures depended on CM1 severity (symptoms' duration, extent of tonsillar ectopia, and tonsil volume).…”

“…2) Headache is a well-known major symptom in CM1 patients and is found in 25-50%. [3][4][5] The radiological prevalence of CM1 in patients with headache is reported as 0.5-1.0% both in adults and in children. [6][7][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 Valsalvalike manoeuvres."…”

“…Headache is a well-known major symptom in CM1 patients and is found in 25–50%. 3 – 5) The radiological prevalence of CM1 in patients with headache is reported as 0.5–1.0% both in adults and in children. 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.…”