Raza-Knight Saba, Mankad Kshitij, Prabhakar Prab, Thompson Dominic
Neurosciences Division, Addenbrooke's Hospital, Cambridge, UK.
Department of Radiology, Great Ormond Street Hospital, London, UK.
Arch Dis Child. 2017 Mar;102(3):238-243. doi: 10.1136/archdischild-2016-310662. Epub 2017 Jan 4.
A common symptom of Chiari I malformation (CIM) is headache, which is diagnosed using non-validated criteria from the International Headache Society (IHS). CIM-associated headaches should resolve following neurosurgical treatment of the malformation by foramen magnum decompression (FMD). We aimed to validate the IHS criteria and determine (1) the efficacy of FMD in treating headache and (2) whether duraplasty confers an advantage over simple bony decompression in the treatment of this symptom.
A retrospective review of CIM cases treated with FMD at Great Ormond Street Hospital from 1989 to 2014 was carried out. Clinical headache characteristics were compared against IHS criteria and correlated with outcome following FMD.
Headache was a presenting symptom in 57/102 (55.9%) of patients. Of these, 42/57 (73.7%) could be classified as Chiari I-type headache. Following FMD, 42/57 (73.7%) of all presenting headaches showed a sustained improvement (>3 months) compared with 32/39 (82.1%) of Chiari I-type headaches. Duraplasty led to a sustained improvement in headache in 32/38 (84.2%) cases compared with 9/16 (56.3%) cases treated with bone-only decompression.
Our data suggest that 80% of headaches classified as Chiari I-type will show a sustained improvement following FMD, and, as such, the IHS criteria are clinically useful in evaluating symptoms attributable to CIM. For all headaches associated with CIM, duraplasty may confer a benefit in terms of long-term improvement, compared with bone-only decompression.
Chiari I型畸形（CIM）的一个常见症状是头痛，目前使用国际头痛协会（IHS）未经验证的标准进行诊断。与CIM相关的头痛应在通过枕骨大孔减压术（FMD）对该畸形进行神经外科治疗后得到缓解。我们旨在验证IHS标准，并确定（1）FMD治疗头痛的疗效，以及（2）在治疗该症状方面，硬脑膜成形术是否比单纯骨减压具有优势。
对1989年至2014年在大奥蒙德街医院接受FMD治疗的CIM病例进行回顾性研究。将临床头痛特征与IHS标准进行比较，并与FMD后的结果相关联。
头痛是102例患者中57例（55.9%）的首发症状。其中，42例（73.7%）可归类为Chiari I型头痛。FMD后，所有首发头痛中有42例（73.7%）显示持续改善（>3个月），而Chiari I型头痛中有32例（82.1%）。硬脑膜成形术使38例中的32例（84.2%）头痛得到持续改善，而单纯骨减压治疗的16例中有9例（56.3%）。
我们的数据表明，80%被归类为Chiari I型的头痛在FMD后将显示持续改善，因此，IHS标准在评估CIM所致症状方面具有临床实用性。对于所有与CIM相关的头痛，与单纯骨减压相比，硬脑膜成形术在长期改善方面可能有益。
