Surgical or conservative treatment of an adult patient with a natural course of Chiari I malformation, what should we choose? (brief literature review, clinical case)

Abstract

Special attention in medicine is paid to a personalized approach to treating patients. Pathology of the craniovertebral junction — Chiari type I malformation has a natural and asymptomatic course. The article provides a literature review of clinical symptoms in non-operated adult patients with a natural course of Chiari type I malformation. A frequent complaint among patients with an asymptomatic course of Chiari type I malformation was headache (77 %). In the structure of cephalgia, the most common forms were: headache associated with cough — 34 %, with migraine — 21.4 % and headache associated with cough and migraine — 21.8 %. Comparative data of surgical and conservative treatment of patients with cephalgic syndrome with Chiari type I malformation. So, cough-related headaches decreased by 95 % after surgery and by 40 % after conservative treatment. In other headaches, pain intensity decreased by 93 % and 61.5 % after conservative and surgical treatment, respectively. A more balanced approach is needed when choosing the tactics of treating these patients. Clinical follow-up of patient K., 58 years old, who has been seen by neurologists, neurosurgeons, chiropractors for Chiari I malformation for 26 years. The patient is a professional ballerina, but the course of her disease did not affect her career and did not lead to surgical intervention. Tactics of management type, there are still no clear criteria for the treatment of asymptomatic and asymptomatic patients with Chiari I malformation. It is necessary to carefully evaluate the nature of structural changes in the brain, the clinical course of the disease, and individually determine the tactics and personalized treatment approach.