Chiari畸形Ⅰ型患者头痛症状的诊断、分类和治疗

Diagnosis, classification, and management of headache in patients with Chiari malformation I

摘要:

Chiari畸形I型（CM-I）是颅颈交界区的先天发育畸形，头痛是其典型症状。随着对CM-I头痛的深入研究，专家学者们逐渐甄别出CM-I患者中广泛存在的不典型疼痛，从而CM-I头痛逐渐被划分为典型头痛和非典型头痛两类。当前，CM-I非典型头痛是否与CM-I的病理生理相关争议较大。同时，针对这两类疼痛管理方案的选择也存在较大争议，这些分歧之间的差异明显并且将在一定时期内存在。此外，现有的证据已经对CM-I头痛有了较为全面的认识，虽然通过手术能取得确切的效果，但保守治疗与手术、单纯后颅窝减压术(PFD)和后颅窝减压硬膜成形术(PFDD)分别对两类头痛患者的复发率和疗效尚待探讨。该文对既往有关争议进行汇总和分析，根据对CM-I典型/非典型两类疼痛不同处理方式的诊治效果提出了建议。未来，手术与非手术方式相结合、精细化个体化管理CM-I患者头痛是诊治CM-I的发展方向。

Abstract:

Chiari malformation type I （CM-I） is a congenital malformation at the craniocervical junction with headache as its typical symptom. With advancements in the research on CM-I headache， the atypical pain widely present in CM-I patients has been gradually recognized. As a result， CM-I headaches have been divided into two categories： typical and atypical headaches. It is controversial whether atypical CM-I headaches are related to the pathophysiology of CM-I and which management plan should be used for the two types of CM-I headaches. These apparent controversies will persist for a long time. In addition， available evidence provides a comprehensive understanding of CM-I headaches. Although surgical interventions have clear benefits， the recurrence rates and treatment outcomes for patients with two types of headaches who receive conservative treatment versus surgery and posterior fossa decompression with duraplasty versus posterior fossa decompression remain to be explored. This literature review summarizes and analyzes the previous controversies， and makes recommendations for the management of CM-I typical and atypical headaches based on the efficacy of different treatments. In the future， the combination of surgery and conservative treatments as well as refined and individualized management of headache in patients with CM-I are directions for the diagnosis and treatment of CM-I.