Predictive Factors of Headache Resolution After Chiari Type 1 Malformation Surgery

Grangeon, Lou; Puy, Laurent; Gilard, Vianney; Hébant, Benjamin; Langlois, Olivier; Derrey, Stéphane; Gérardin, Emmanuel; Maltête, David; Guégan-Massardier, Évelyne; Magné, Nicolas

doi:10.1016/j.wneu.2017.10.070

Cited by 31 publications

(16 citation statements)

References 30 publications

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“…The 4 CCOS domains were each dichotomized into favorable (score of 3 or 4) or unfavorable (score of 1 or 2) outcome, and a favorable overall outcome was defined as a total CCOS score ranging from 13 to 16, as has been described previously. 4,11 Since depression may affect outcome in any 1 of the 4 CCOS domains, univariable analysis was performed to evaluate potential associations between baseline variables and any of the 4 CCOS domains as well as the composite CCOS score. Since the CSI already includes several key clinical variables such as headache and myelopathy symptoms, clinical symptoms were only included in the analysis if they differed significantly between depressed and nondepressed patients (possible confounders).…”

Section: Discussionmentioning

confidence: 99%

The impact of depression on surgical outcome in Chiari malformation type I: an assessment based on the Chicago Chiari Outcome Scale

Feghali

Chen

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe effect of depression on outcomes in Chiari malformation type I (CM-1) is unclear. The authors sought to determine whether depression affects outcome in a surgical cohort of CM-1 patients by using a validated outcome assessment tool, the Chicago Chiari Outcome Scale (CCOS).METHODSThe authors performed a retrospective analysis of a prospectively maintained database of 149 adult CM-1 patients undergoing suboccipital decompression with duraplasty and cranioplasty. Baseline presentation characteristics and composite as well as subcomponent CCOS scores at last follow-up were compared between depressed and nondepressed patients. Outcome comparisons included both a univariable analysis and a logistic regression model adjusting for several covariates.RESULTSThe prevalence of depression in the study cohort was 28% (41/149). Baseline demographic and imaging characteristics were similar between the 2 patient groups. Dizziness (p = 0.019) and imbalance (p = 0.015) were significantly more common among depressed patients, but clinical symptoms and severity were otherwise comparable. On univariable analysis, depressed patients were significantly less likely to experience improvement in pain symptoms (OR 0.14, 95% CI 0.03–0.61, p = 0.003) and functionality (OR 0.17, 95% CI 0.03–0.99, p = 0.049). No significant difference was identified in complications, nonpain symptom improvement, or overall composite CCOS improvement. Similar results were obtained on multivariable analysis controlling for several covariates.CONCLUSIONSDepression is independently associated with poor surgical outcome in adult CM-1 patients, namely when evaluating improvement in pain symptoms and functionality. Optimizing the management of depression preoperatively and ensuring follow-up for psychiatric comorbidity in the postoperative period may possibly lead to improved outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of depression on surgical outcome in Chiari malformation type I: an assessment based on the Chicago Chiari Outcome Scale

Feghali

Chen

et al. 2020

Journal of Neurosurgery: Spine

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“…Furthermore, the calculation is complicated and often requires professional software, which limits its clinical application. The volumes of different structures in the skull cavity, including the intracranial volume, PCF volume, supratentorial volume, herniated volume, 4th ventricle volume, and hindbrain volume, have been measured, [4,5,8] but the volumetric measurements failed to predict the response of CMI patients to PFD. As the brain tissue on either side of the median sagittal plane approximates a mirror-symmetric distribution, relevant areas in the median sagittal plane of the PCF are commonly used as morphological parameters.…”

Section: Discussionmentioning

confidence: 99%

“…[2,3] The exact prevalence of CMI in the general population is unclear but, according to one report, the prevalence ranges from 0.5% to 0.9% in adults and is ∼1% in children. [4] The symptoms and signs of CMI reflect the obstruction of cerebrospinal fluid (CSF) flow, compression of the contents in the posterior cranial fossa (PCF), or spinal cord dysfunction. [5] Surgery is the only way to treat CMI, and posterior fossa decompression (PFD) is the standard procedure.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of posterior cranial fossa morphology in the decompression of Chiari malformation type I

Liu

Zheng

et al. 2019

Medicine

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Posterior fossa decompression (PFD) is the standard procedure for the treatment of Chiari malformation type I (CMI). Although most patients have satisfactory surgical outcomes, some show no improvement or even a worsening of symptoms. Patient selection is thought to account for these different surgical outcomes. Our aim was to evaluate the predictive value of the preoperative posterior cranial fossa (PCF) morphology on the efficacy of PFD. Data from 39 CMI patients with CMI-related symptoms who underwent occipital foramen enlargement + C-1 laminectomy + enlarged duraplasty were retrospectively collected from January 2011 to May 2018. The patients were divided into improved and unimproved groups according to the modified Chicago Chiari Outcome Scale. Demographic information and clinical history, including preoperative comorbidities and clinical manifestations, were recorded for the 2 groups and compared. PCF morphology was assessed based on 13 linear, 8 angular, 4 areal parameters and 4 ratios related to these liner and areal parameters. The data were then analyzed statistically. Of the 39 patients with CMI, 24 showed improvement after PFD (61.5%), whereas the remaining 15 patients showed no improvement (38.5%). The preoperative symptoms lasted 1 to 240 months, with a median of 24 months. The follow-up period ranged from 2 to 82 months, with a median of 27 months. The improved and unimproved groups differed significantly with regard to upper limb numbness (OR = 10, P = .02) and upper limb weakness (OR = 4.86, P = .02). The 2 groups did not differ significantly with regard to any morphological parameters such as tonsillar descent, syrinx size. Preoperative upper limb numbness and upper limb weakness are unfavorable factors that influence the outcome of PFD in patients with CMI. However, the morphology of PCF cannot predict the response to PFD in patients with CMI.

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“…3 Grangeon et al tested the CSI on 38 adult CM-I patients; the proportion of improved patients (CCOS ≥ 13) decreased with increasing CSI, but results were not statistically significant, similar to the results of our study. 9 This weak association between CSI and outcomes in the adult population may be the result of important differences between adult and pediatric CM-I. A study by Gilmer at al.…”

Section: The Chiari Severity Indexmentioning

confidence: 99%

External validation of current prediction systems of improvement after decompression surgery in Chiari malformation type I patients: can we do better?

Feghali

Chen

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe Chiari Severity Index (CSI) and points-based algorithm of Thakar et al. are two prognostic tools that have been developed to predict the likelihood of improvement after suboccipital decompression in adult patients with Chiari malformation type I (CM-I). This study aimed to externally validate and critically evaluate these algorithms in the interest of guiding the development of improved prediction systems.METHODSA consecutive cohort of CM-I patients undergoing suboccipital decompression between September 2006 and September 2018 were included. The CSI and Thakar point score were computed for all patients, and associations with improvement were analyzed. The ability of both prediction systems to predict improvement as measured by different Chicago Chiari Outcome Scale (CCOS) cutoffs was assessed using receiver operating curve analysis. Post hoc correlations between the algorithms and different CCOS subcomponents were also assessed.RESULTSThe surgical cohort was composed of 149 adult CM-I patients, of whom 39 (26%) had a syrinx. Most patients experienced improvement after surgery (80% CCOS ≥ 13; 96% CCOS ≥ 11). The proportion of patients improving decreased with increasing CSI, but the results were not statistically significant (p = 0.246). No statistically significant difference in the mean Thakar point score was identified between improved and nonimproved patients using both CCOS cutoffs (p = 0.246 for a cutoff of 13 and p = 0.480 for a cutoff of 11). The CSI had a poor ability in identifying improved patients at a CCOS cutoff of 13 (area under the curve [AUC] 0.582) and 11 (AUC 0.646). The Thakar point score similarly had poor discrimination at a cutoff of 13 (AUC 0.467) and 11 (AUC 0.646). Neither algorithm had significant correlation with any of the CCOS subcomponents except for CSI and nonpain symptom improvement (coefficient = −0.273, p = 0.001).CONCLUSIONSPreviously published algorithms failed to provide prediction value with regard to clinically meaningful improvement following suboccipital decompression in adult CM-I patients. Future models and practical scoring systems are still required to improve the decision-making process.

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Predictive Factors of Headache Resolution After Chiari Type 1 Malformation Surgery

Cited by 31 publications

References 30 publications

The impact of depression on surgical outcome in Chiari malformation type I: an assessment based on the Chicago Chiari Outcome Scale

The impact of depression on surgical outcome in Chiari malformation type I: an assessment based on the Chicago Chiari Outcome Scale

Predictive value of posterior cranial fossa morphology in the decompression of Chiari malformation type I

External validation of current prediction systems of improvement after decompression surgery in Chiari malformation type I patients: can we do better?

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