Hergünsel Batu, Ertuğrul Bilal, Erol Fatih Serhat, Gönen Murat, Kaplan Metin
Department of Neurosurgery, Sisli Hamidiye Etfal Medical Practice and Research Center, University of Health Sciences, Istanbul, Turkey.
Department of Neurosurgery, Firat University, Elazig, Turkey.
World Neurosurg. 2025 Jan;193:791-795. doi: 10.1016/j.wneu.2024.10.049. Epub 2024 Nov 13.
Headache (HA) is the most common symptom impacting the quality of life of patients with Chiari I malformation. While HAs typically present in the occipital or suboccipital regions, and induced by Valsalva maneuver, complex migraine-like HAs referring to frontal or orbital regions also occur. Our study explores the therapeutic potential of C1 nerve root decompression in addition to increasing intracranial compliance in patients with Chiari I malformation.
We retrospectively analyzed cases operated on for Chiari I malformation, focusing on patients with nonsuboccipital, non-Valsalva induced HAs. Preoperative and postoperative visual analog scale scores and HA frequency were recorded. Surgical technique involved suboccipital craniectomy, C1 laminectomy, cerebellar tonsil reduction, and C1 root decompression.
Twelve patients (10 females, 2 males) aged 22-52 years were included. Preoperative mean visual analog scale score was 8, which improved to 2 or less in 11 patients postoperatively. The mean HA frequency decreased significantly.
Our findings suggest that C1 root compression contributes to atypical HAs in Chiari I malformation and that C1 root decompression may improve surgical outcomes.
头痛（HA）是影响 Chiari I 型畸形患者生活质量的最常见症状。虽然头痛通常出现在枕部或枕下区域，并由瓦尔萨尔瓦动作诱发，但也会出现涉及额部或眶部区域的复杂偏头痛样头痛。我们的研究除了探讨增加 Chiari I 型畸形患者的颅内顺应性外，还探索了 C1 神经根减压的治疗潜力。
我们回顾性分析了接受 Chiari I 型畸形手术的病例，重点关注非枕下、非瓦尔萨尔瓦动作诱发头痛的患者。记录术前和术后视觉模拟量表评分及头痛频率。手术技术包括枕下颅骨切除术、C1 椎板切除术、小脑扁桃体减压和 C1 神经根减压。
纳入了 12 例年龄在 22 - 52 岁之间的患者（10 名女性，2 名男性）。术前平均视觉模拟量表评分为 8 分，术后 11 名患者改善至 2 分或更低。平均头痛频率显著降低。
我们的研究结果表明，C1 神经根受压导致 Chiari I 型畸形患者出现非典型头痛，且 C1 神经根减压可能改善手术效果。
