Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, China.
Cephalalgia. 2023 Jan;43(1):3331024221131356. doi: 10.1177/03331024221131356.
A meta-analysis was conducted to analyze the incidence of typical and atypical headaches and outcomes following various treatments in patients with Chiari I malformation.
Headache is the most common symptom of Chiari malformation, which can be divided into typical and atypical subgroups to facilitate management. Much controversy surrounds the etiology, prevalence and optimal therapeutic approach for both types of headaches.
We identified relevant studies published before 30 July 2022, with an electronic search of numerous literature databases. The results of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
A total of 1913 Chiari malformation type I CIM patients were identified, 78% of whom presented with headache, within this group cephalgia was typical in 48% and atypical in 29% of patients, and migraine was the most common type of atypical headache. The ratio of typical/atypical headaches with international classification of headache disorders diagnosis was 1.53, and without international classification of headache disorders diagnosis was 1.56, respectively. The pooled improvement rates of typical headaches following conservative treatment, extradural decompression and intradural decompression were 69%, 88%, and 92%, respectively. The corresponding improvement rates for atypical headaches were 70%, 57.47%, and 69%, respectively. The complication rate in extradural decompression group was significantly lower than in intradural decompression group (RR, 0.31; 95% CI: 0.06-1.59, I = 50%, = 0.14). Low reoperation rates were observed for refractory headaches in extradural decompression and intradural decompression groups (1%).
The International Classification of Headache Disorders can assist in screening atypical headaches. extradural decompression is preferred for typical headaches, while conservative therapy is optimal for atypical headaches. A definite correlation exists between atypical headaches and Chiari Malformation Type I patients with higher prevalence than in the general population. Importantly, decompression is effective in relieving headaches in this particular patient population.
通过荟萃分析，分析 Chiari I 畸形患者接受各种治疗后的典型和非典型头痛发生率和结局。
头痛是 Chiari 畸形最常见的症状，可以分为典型和非典型亚组，以方便管理。对于这两种类型的头痛，其病因、患病率和最佳治疗方法存在很大争议。
我们在 2022 年 7 月 30 日之前检索了大量文献数据库，确定了相关研究。本研究的结果按照系统评价和荟萃分析的首选报告项目进行了报告。
共纳入 1913 例 Chiari 畸形 I 型（CIM）患者，其中 78%存在头痛，头痛患者中 48%为典型头痛，29%为非典型头痛，偏头痛是最常见的非典型头痛类型。国际头痛疾病分类诊断的典型/非典型头痛比为 1.53，无国际头痛疾病分类诊断的比为 1.56。保守治疗、硬膜外减压和硬脑膜内减压后典型头痛的总体改善率分别为 69%、88%和 92%。非典型头痛的相应改善率分别为 70%、57.47%和 69%。硬膜外减压组的并发症发生率明显低于硬脑膜内减压组（RR，0.31；95%CI：0.06-1.59，I=50%，P=0.14）。硬膜外减压和硬脑膜内减压组难治性头痛的再次手术率均较低（1%）。
国际头痛疾病分类有助于筛选非典型头痛。硬膜外减压是治疗典型头痛的首选方法，而保守治疗是治疗非典型头痛的最佳方法。非典型头痛与 Chiari 畸形 I 型患者存在明确相关性，其患病率高于普通人群。重要的是，减压对该特定患者人群的头痛有效。
