Long-term outcome for headaches in patients with Chiari Malformation Type 1 after foramen magnum decompression
EANS Academy. Hamdan A. 09/25/19; 275539; EP02126
Dr. Alhafidz Hamdan
Dr. Alhafidz Hamdan

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Abstract
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Background: Management of Chiari Malformation Type 1 (CM1) remains controversial. Most studies included in meta-analyses of CM1 outcomes only analysed short-term (< 1 year) outcomes, and some studies did not clearly analyse headache and clinical syringomyelia outcomes separately. We studied long-term (>1 year) outcomes for CM1 patients with headaches and analysed potential predictive factors for good outcome.
Methods: We retrospectively correlated 76 CM1 patients' long-term headache outcome (2012-17) with demographic and radiological features, treatments (foramen magnum decompression with/without duraplasty; FMD+D/FMD-D), complications, and short-term outcomes. We defined good and poor outcomes as improved, and unchanged/worsened headaches, respectively. Median durations for short- and long-term follow-ups were 8.5 ± 0.2, and 32.4 ± 16.3 months respectively.
Results:
Twenty-five (32.9%) patients were < 18 years (median 24.5 ± 13.9 years) and 48 (63.2%) patients were females. Sixteen (21%) had headaches only and 60 (78.9%) had headaches plus clinical syringomyelia. Fifty-seven (75%) and 19 (25%) patients underwent FMD+D and FMD-D respectively. Twenty-two (28.9%) patients had all-cause complications and 13 (17.1%) had CSF-related complications.
Thirty-eight (56.7%) patients had a good short-term outcome, whereas only 22 (42.3%) had a good long-term outcome, reflecting a significant rate of delayed symptom recurrence. Univariate analyses revealed age, gender, tonsillar descent, and short-term outcome were predictive of long-term outcome. In multivariate analysis, only tonsillar descent and short-term outcome remained predictive.
When comparing FMD+D vs FMD-D, the former had a longer hospital stay (median of 8 ± 12.6 vs 5 ± 3.6, P< 0.05), with no difference in complication and recurrence rates, and short-term, and long-term outcomes.
Conclusions:
Long-term headache outcomes in CM1 were poor. Randomised trials on CM1 treatments are warranted; we propose that future trials should separate headaches and clinical syringomyelia outcomes, and should include long-term outcomes, in order to better define treatment effect on symptom resolution in CM1 patients.
Background: Management of Chiari Malformation Type 1 (CM1) remains controversial. Most studies included in meta-analyses of CM1 outcomes only analysed short-term (< 1 year) outcomes, and some studies did not clearly analyse headache and clinical syringomyelia outcomes separately. We studied long-term (>1 year) outcomes for CM1 patients with headaches and analysed potential predictive factors for good outcome.
Methods: We retrospectively correlated 76 CM1 patients' long-term headache outcome (2012-17) with demographic and radiological features, treatments (foramen magnum decompression with/without duraplasty; FMD+D/FMD-D), complications, and short-term outcomes. We defined good and poor outcomes as improved, and unchanged/worsened headaches, respectively. Median durations for short- and long-term follow-ups were 8.5 ± 0.2, and 32.4 ± 16.3 months respectively.
Results:
Twenty-five (32.9%) patients were < 18 years (median 24.5 ± 13.9 years) and 48 (63.2%) patients were females. Sixteen (21%) had headaches only and 60 (78.9%) had headaches plus clinical syringomyelia. Fifty-seven (75%) and 19 (25%) patients underwent FMD+D and FMD-D respectively. Twenty-two (28.9%) patients had all-cause complications and 13 (17.1%) had CSF-related complications.
Thirty-eight (56.7%) patients had a good short-term outcome, whereas only 22 (42.3%) had a good long-term outcome, reflecting a significant rate of delayed symptom recurrence. Univariate analyses revealed age, gender, tonsillar descent, and short-term outcome were predictive of long-term outcome. In multivariate analysis, only tonsillar descent and short-term outcome remained predictive.
When comparing FMD+D vs FMD-D, the former had a longer hospital stay (median of 8 ± 12.6 vs 5 ± 3.6, P< 0.05), with no difference in complication and recurrence rates, and short-term, and long-term outcomes.
Conclusions:
Long-term headache outcomes in CM1 were poor. Randomised trials on CM1 treatments are warranted; we propose that future trials should separate headaches and clinical syringomyelia outcomes, and should include long-term outcomes, in order to better define treatment effect on symptom resolution in CM1 patients.
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