Correlation of cerebrospinal fluid flow dynamics and headache in Chiari I malformation
Correlation of cerebrospinal fluid flow dynamics and headache in Chiari I malformation
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DOI：
10.1227/01.neu.0000156203.20659.14
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发表时间：
2005-04-01
期刊：
影响因子：
4.8
通讯作者：
George, TM
中科院分区：
文献类型：
--
作者：
McGirt, MJ;Nimjee, SM;George, TM
目的：基亚里I畸形患者仅表现为头痛的治疗尚不清楚。我们研究了基亚里I畸形患者的脑脊液（CSF）流动动力学，以确定与脑脊液流动阻塞相关的头痛类型与可能与基亚里I畸形无关的头痛类型。对33例仅表现为头痛和基亚里I型畸形的患者进行了前瞻性的颅颈交界部术前电影相位对比磁共振成像（扁桃体异位>枕骨大孔下5 mm）。头痛分为额叶、枕叶或全身性头痛。然后前瞻性比较脑脊液流动动力学与目前的脑血管病。17名患者的一个亚组接受了基亚里I畸形的手术减压。结果：额叶或全身性头痛患者表现为脑脊液流动受阻的可能性低10倍（比值比，0.10; 95%置信区间，0.02-0.52）和扁桃体下降大于7 mm的可能性降低8倍（比值比，0.12; 95%置信区间，0.03-0.62）与枕部头痛患者相比。在多变量分析中调整扁桃体疝的程度，额部和全身性头痛与非阻塞性脑脊液流病理结果独立相关，而枕部头痛与阻塞性脑脊液流相关，与扁桃体位置无关（比值比，5.84; 95%置信区间，1.01-34.28）。在手术组中，所有患者的脑脊液流动受阻，以及与正常流量组相比，无论头痛location.CONCLUSION：无论扁桃体异位的程度，枕部头痛与后脑脑脊液流量异常，而额叶和全身性头痛没有强烈的相关性。正常的磁共振成像电影脑脊液流量在设置一个基亚里I畸形和额叶头痛单独表明，额叶头痛是没有病理或因果关系与基亚里I畸形在绝大多数患者。额部头痛伴血流受阻可能需要手术治疗。
OBJECTIVE: The management of patients with a Chiari I malformation who present with headaches alone remains unclear. We studied the cerebrospinal fluid (CSF) flow dynamics of Chiari I malformation patients presenting with headaches alone so as to identify headache types that are associated with CSF flow obstruction versus those that may be unrelated to Chiari I malformations.METHODS: Preoperative cine phase-contrast magnetic resonance imaging of the craniocervical junction was prospectively performed in 33 patients presenting with headaches alone and a Chiari I malformation (tonsillar ectopia > 5 mm below the foramen magnum). Headaches were classified as frontal, occipital, or generalized. CSF flow dynamics were then prospectively compared with presenting symptomatology. A subgroup of 17 patients underwent surgical decompression of the Chiari I malformations.RESULTS: Patients with frontal or generalized headaches were 10-fold less likely to demonstrate obstructed CSF flow (odds ratio, 0.10; 95% confidence interval, 0.02-0.52) and 8-fold less likely to have tonsillar descent greater than 7 mm (odds ratio, 0.12; 95% confidence interval, 0.03-0.62) compared with patients with occipital headaches. Adjusting for degree of tonsillar herniation in multivariate analysis, frontal and generalized headaches remained independently associated with nonobstructed CSF flow pathological findings, whereas occipital headaches remained associated with obstructed CSF flow independent of tonsil location (odds ratio, 5.84; 95% confidence interval, 1.01-34.28). In the surgical group, all patients with obstructed CSF flow did well compared with the group with normal flow, regardless of headache location.CONCLUSION: Regardless of the degree of tonsillar ectopia, occipital headaches were strongly associated with hindbrain CSF flow abnormalities, whereas frontal and generalized headaches were not. Normal magnetic resonance imaging-cine CSF flow in the setting of a Chiari I malformation and frontal headaches alone suggests that frontal headaches are not pathologically or causatively associated with the Chiari I malformation in the vast majority of patients. Frontal headaches with obstructed flow may respond to surgery.