Choosing an anesthetic technique in pregnant women with Arnold – Chiari malformation

  • V. D. Zukin Maternity Hospital “Leleka”, Kyiv
  • Ye. V. Grigimalsky Maternity Hospital “Leleka”, Kyiv
  • A. Y. Garga Maternity Hospital “Leleka”, Kyiv
Keywords: Chiari malformation, caeserian section, anaesthesia, epidural anaesthesia


We want to present the clinical case of a female patient with the asymptomatic Chiari I type malformation, without surgical correction and with concomitant epilepsy who underwent planned C-section under epidural anesthesia. A 29-year old pregnant women on the 39 week of pregnancy entered the maternity hospital for the delivery. It was decided to conduct a planned caesarean section. The epidural anesthesia with 0.75 % solution of the ropivacaine was chosen as the method of anesthesia. The patient did not receive antiepileptic treatment due to her implacable refusal. She underwent surgery and anesthesia well. On the third day after surgery, the patient suffered of a convulsive as sault, which was stopped by intravenous administration of diazepam. This article briefly describes the genetic background, classification, clinical manifestations and treatment tactics for patients with Chiari malformation and the features of C-section anesthesia in pregnant women with this pathology.


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Sarnat HB. Disorders of segmentation of the neuraltube: Chiari malformations // HandbClinNeurol 2008; 87: 89.

Sarnat HB. Regional ependymal up regulation of vimentinin Chiari II malformation, aqueductal stenosis, andhydromyelia // PediatrDevPathol 2004; 7: 48.

Penfield W, Coburn DF. Arnold–Chiari malformation an dits operative treatment // ArchNeurolPsychiat 1938; 40: 328.

Milhorat TH, Chou MW, Trinidad EM, etal. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients // Neurosurgery 1999; 44: 1005.

Marin-Padilla M, Marin-Padilla TM. Morphogenesis of experimentally induced Arnold-Chiari malformation // J NeurolSci 1981; 50: 29.

McLone DG, Knepper PA. Thecauseof Chiari II malformation: a unifiedtheory // PediatrNeurosci 1989; 15: 1.

Peach B (1965) The Arnold-Chiari malformation // ArchNeurol 12: 613.

Schijman E. History, anatomic forms, and pathogenesis of Chiari I malformations // ChildsNervSyst. 2004; 20: 323.

Raimondi AJ, Cerullo LJ (1980) Pediatric cerebral angiography. In: Nadjmi M (ed) A descriptiveatlas. Thieme,Stuttgart, pp. 140–141.

Tubbs RS, Elton S, Grabb P, etal. Analysis of the posterior fossainchildren with the Chiari 0 malformation // Neurosurgery 2001; 48: 1050.

Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ. A critical analysis of the Chiari 1.5 malformation // J Neurosurg 2004; 101: 179.

Haddad FA, Qaisi I, Joudeh N, Dajani H, Jumah F, Elmashala A, Adeeb N, Chern JJ, Tubbs RS. The Newer Classifications of the Chiari Malformations with Clarifications: An Anatomical Review. ClinAnat. 2018 Jan 18.

Speer MC, Enterline DS, Mehltretter L. Chiaritype I malformation with or without syringomyelia: prevalence and genetics. J GenetCouns 2003; 12:297.

Goh S, Bottrell CL, Aiken AH, etal. Presyrinx in children with Chiari malformations. Neurology 2008; 71:351.

Ferré Á, Poca MA, delaCalzada MD, etal. Sleep-Related Breathing Disorders in Chiari MalformationType 1: A Prospective Studyof 90 Patients. Sleep 2017; 40.

Steinbok P. Clinical features of Chiari I malformations. ChildsNervSyst 2004; 20:329.

Caldarelli M, DiRocco C. Diagnosis of Chiari I malformation and related syringomyelia: radiological and neurophysiological studies. ChildsNervSyst 2004; 20:332.

Vandertop WP, Asai A, Hoffman HJ, etal. Surgical decompression for symptomatic Chiari II malformation in neonates with myelomeningocele // J Neurosurg 1992; 77: 541.

Schijman E, Steinbok P. International surveyon the management of Chiari I malformation and syringomyelia // ChildsNervSyst. 2004; 20: 341.

Pakzaban P. Chiari malformation. http://emedicine.medscape. com/article/1483583-overview (AccessedonJuly 28, 2010).

Nel M.R., Robson V., Robinson P. N. Extradural anaesthesia for caesarean sectionin a patient with syringomyelia and Chiaritype I anomaly// Br. J. Anaesth. 1998; 80: 512–515.

Ramsis F. Ghaly, Kenneth D. Candido, RubenSauer, NebojsaNickKnezevic. Anesthetic management during Cesarean sectionin a woman with residual Arnold–Chiari malformationType I, cervical kyphosis, and syringomyelia // SurgNeurolInt. 2012; 3: 26.

Su TM, Lan CM, Yang LC, Lee TC, Wang KW, HungKS. BrainTumor Presenting with Fatal Herniation following Deliveryunder Epidural Anesthesia // Anesthesiology. 2 2002, Vol. 96, 508–509.

How to Cite
Zukin VD, Grigimalsky YV, Garga AY. Choosing an anesthetic technique in pregnant women with Arnold – Chiari malformation. PMJUA [Internet]. 2018Aug.1 [cited 2019Jun.26];3(2):75-9. Available from:
Clinical discussion