Lynch Benjamin T, Hartman Emma K, Karsten Madeline B, Slingerland Anna L, Staffa Steven J, Proctor Mark R, Cravero Joseph P
1Department of Neurosurgery, Boston Children's Hospital, Boston; and.
2Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
J Neurosurg Pediatr. 2025 May 9;36(2):201-207. doi: 10.3171/2025.2.PEDS24356. Print 2025 Aug 1.
This study seeks to report the incidence and type of headache in pediatric patients with Chiari malformation type I (CM-I) at a single institution as well as headache outcomes based on management strategy (surgical vs medical).
A single-institution retrospective review from January 2003 to May 2020 identified all consecutive pediatric patients who were diagnosed with CM-I and who experienced headaches. Headaches were classified as typical, some features, and atypical CM-I headaches based on the International Classification of Headache Disorders criteria. Short- (< 6 months) and long-term (> 6 months) headache outcomes were classified as improvement or no improvement based on specific phrases in patient charts.
A total of 112 patients met inclusion criteria. Forty patients (35.7%) experienced typical CM-I headache, 42 (37.5%) experienced some features of a CM-I headache, and 30 (26.8%) experienced atypical CM-I headache. Of the 112 total patients, 48 (42.9%) received surgical treatment for CM-I and 64 (57.1%) were managed medically. The decision to perform surgery was made at the discretion of the treating neurosurgeon in discussion with the family, and was influenced by the severity of symptoms, the presence of other neurological findings on examination, and the presence of an associated syrinx. There was no statistically significant difference in headache improvement between surgical and medical treatment regardless of headache classification. Non-White race and the presence of a syrinx were statistically significant predictors of short-term headache improvement, and female gender was a statistically significant negative predictor of long-term headache improvement.
In this observational cohort of pediatric patients with CM-I, the authors found no difference in headache outcomes based on management strategy, regardless of the nature of the headache symptoms on presentation.
本研究旨在报告单一机构中I型Chiari畸形（CM-I）儿科患者的头痛发生率和类型，以及基于治疗策略（手术与药物治疗）的头痛治疗结果。
对2003年1月至2020年5月在单一机构进行的回顾性研究，确定了所有连续诊断为CM-I且有头痛症状的儿科患者。根据《头痛疾病国际分类》标准，将头痛分为典型、部分特征性和非典型CM-I头痛。根据患者病历中的特定表述，将短期（<6个月）和长期（>6个月）头痛治疗结果分为改善或未改善。
共有112例患者符合纳入标准。40例（35.7%）经历典型CM-I头痛，42例（37.5%）有CM-I头痛的部分特征，30例（26.8%）经历非典型CM-I头痛。在112例患者中，48例（42.9%）接受了CM-I手术治疗，64例（57.1%）接受药物治疗。手术决定由主治神经外科医生与家属讨论后自行决定，受症状严重程度、检查中其他神经学发现以及是否存在相关脊髓空洞症影响。无论头痛分类如何，手术和药物治疗在头痛改善方面均无统计学显著差异。非白种人和存在脊髓空洞症是短期头痛改善的统计学显著预测因素，女性是长期头痛改善的统计学显著负性预测因素。
在这个CM-I儿科患者观察队列中，作者发现无论就诊时头痛症状的性质如何，基于治疗策略的头痛治疗结果无差异。
