Introduction: While post-operative outcomes of Chiari I malformation patients have been well-reported, there is a paucity of literature concerning non-operative management in these patients. We conducted an analysis of clinical outcomes in Chiari I patients treated conservatively.
Methods: We retrospectively identified patients with a diagnosis of Chiari I malformation that were not recommended for surgery based on lack of clinical objective findings or inconsistent cough headaches and obtained follow-up with a telephone survey. Patients were referred to a headache specialist for medical management. We analyzed clinical data using chi square analysis and logistic regression models.
Results: Of the 68 patients (mean age at diagnosis: 30.1 ± 17.4 years), 72% were female, 29% were male and 31% were pediatric patients (age at diagnosis =18 years). Average follow up was 4.9 ± 2.9 years. 16% of patients presented with cough headaches, 29% with migraines or non-specific headaches, 28% reported both while 26% reported no headaches at all. Patients often presented with other subjective symptoms including dysphagia, paresthesias, nausea and ataxia. 40% of patients that had cough headache and 61.5% of patients with non-specific headaches reported improvement. The presence of subjective sensory symptoms was significantly associated with less likelihood of cough headache improvement (p = 0.0049). However, the remaining factors (dysphagia, nausea, ataxia) were not significant predictors of clinical changes of cough headaches. The presence of a cough headache was also associated with a lower likelihood of improvement in all non-cough symptoms (p= 0.0049).
Conclusions: Through application of our surgical decision algorithm, we found that many symptoms of Chiari I malformation patients from our conservative cohort either improved or remained unchanged over time. However, the presence of cough headaches was a significant negative predictor of concomitant symptom improvement. This further validates that patients with cough headaches should be considered for surgical intervention.
Patient Care: We hope that our findings will elucidate predictors that can be used to help determine the course of treatment for Chiari Malformation Type I patients.
Learning Objectives: Describe the outcomes of Chiari I patients that were managed without operative treatment.
Determine possible key predictors of outcomes of conservatively managed patients.