SEMANTICS AND DYNAMICS OF HEADACHE IN PATIENTS WITH CHIARI MALFORMATION TYPE I AFTER DECOMPRESSION SURGERY: EXPERIENCE FROM AZERBAIJAN.

Abstract

Introduction: Chiari malformation type I (CMI) is a congenital anomaly characterized by the descent of the cerebellar tonsils into the foramen magnum (FM), leading to cerebrospinal fluid circulation disturbances at the level of the posterior cranial fossa (PCF) and the craniovertebral junction (CVJ). Headache (HA) is the predominant symptom, often mimicking primary cephalalgias, complicating diagnosis and optimal surgical strategy selection.

Aim of the study: To analyze the characteristics of headache in CMI, identify the pathophysiological mechanisms of typical (tHA) and atypical headaches (aHA), and assess the effectiveness of different decompressive surgical techniques in postoperative pain relief.

Materials and methods: The study included 102 patients (58 females, 44 males, aged 2-69) with isolated or complicated CMI who underwent decompressive surgery at the Neurosurgery Department of Azerbaijan Medical University and the Republican Neurosurgical Center (2016-2024). Patients were divided into two groups based on headache type: typical HA (tHA, n=82) and atypical HA (aHA, n=20). Headache characteristics and dynamics were assessed using neurological and neuroimaging monitoring.

Results: Decompression surgery significantly reduced headache severity, particularly in tHA patients. The best outcomes for aHA patients were observed with intra-arachnoid dissection and duraplasty.

Conclusion: The findings can contribute to optimizing surgical approaches for CMI treatment.