Choosing an anesthetic technique in pregnant women with Arnold – Chiari malformation
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.
Sarnat HB. Disorders of segmentation of the neural tube: Chiari malformations. Handbook of Clinical Neurology [Internet]. Elsevier; 2007;89–103. Available from: https://doi.org/10.1016/s0072-9752(07)87006-0
Sarnat HB. Regional Ependymal Upregulation of Vimentin in Chiari II Malformation, Aqueductal Stenosis, and Hydromyelia. Pediatric and Developmental Pathology [Internet]. SAGE Publications; 2004 Feb;7(1). Available from: https://doi.org/10.1007/s10024-003-2127-5
Penfield W. Arnold-chiari malformation and its operative treatment. Archives of Neurology And Psychiatry [Internet]. American Medical Association (AMA); 1938 Aug 1;40(2):328. Available from: https://doi.org/10.1001/archneurpsyc.1938.02270080112007
Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I Malformation Redefined: Clinical and Radiographic Findings for 364 Symptomatic Patients. Neurosurgery [Internet]. Oxford University Press (OUP); 1999 May;44(5):1005–17. Available from: https://doi.org/10.1097/00006123-199905000-00042
Marin-Padilla M, Marin-Padilla TM. Morphogenesis of experimentally induced arnold-chiari malformation. Journal of the Neurological Sciences [Internet]. Elsevier BV; 1981 Apr;50(1):29–55. Available from: https://doi.org/10.1016/0022-510x(81)90040-x
McLone DG, Knepper PA. The Cause of Chiari II Malformation: A Unified Theory. Pediatric Neurosurgery [Internet]. S. Karger AG; 1989;15(1):1–12. Available from: https://doi.org/10.1159/000120432
PEACH B. The Arnold-Chiari Malformation. Archives of Neurology [Internet]. American Medical Association (AMA); 1965 May 1;12(5):527. Available from: https://doi.org/10.1001/archneur.1965.00460290083009
Schijman E. History, anatomic forms, and pathogenesis of Chiari I malformations. Child’s Nervous System [Internet]. Springer Science and Business Media LLC; 2004 May 1;20(5):323–8. Available from: https://doi.org/10.1007/s00381-003-0878-y
Raimondi AJ, Cerullo LJ. Pediatric Cerebral Angiography; a Descriptive Atlas. Thieme; 1980.
Tubbs RS, Elton S, Grabb P, Dockery SE, Bartolucci AA, Oakes WJ. Analysis of the Posterior Fossa in Children with the Chiari 0 Malformation. Neurosurgery [Internet]. Oxford University Press (OUP); 2001 May;48(5):1050–5. Available from: https://doi.org/10.1227/00006123-200105000-00016
Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ. A critical analysis of the Chiari 1.5 malformation. Journal of Neurosurgery: Pediatrics [Internet]. Journal of Neurosurgery Publishing Group (JNSPG); 2004 Nov;101(2):179–83. Available from: https://doi.org/10.3171/ped.2004.101.2.0179
Azahraa Haddad F, Qaisi I, Joudeh N, Dajani H, Jumah F, Elmashala A, et al. The newer classifications of the chiari malformations with clarifications: An anatomical review. Clinical Anatomy [Internet]. Wiley; 2018 Feb 20;31(3):314–22. Available from: https://doi.org/10.1002/ca.23051
Speer MC, Enterline DS, Mehltretter L, Hammock P, Joseph J, Dickerson M, et al. Review Article: Chiari Type I Malformation with or Without Syringomyelia: Prevalence and Genetics. J Genet Couns. 2003 Aug;12(4):297-311.
Goh S, Bottrell CL, Aiken AH, Dillon WP, Wu YW. Presyrinx in children with Chiari malformations. Neurology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Jun 18;71(5):351–6. Available from: https://doi.org/10.1212/01.wnl.0000304087.91204.95
Ferré Á, Poca MA, de la Calzada MD, Moncho D, Romero O, Sampol G, et al. Sleep-Related Breathing Disorders in Chiari Malformation Type 1: A Prospective Study of 90 Patients. Sleep [Internet]. Oxford University Press (OUP); 2017 Apr 27;40(6). Available from: https://doi.org/10.1093/sleep/zsx069
Steinbok P. Clinical features of Chiari I malformations. Child's Nervous System. 2004 May 1;20(5):329-31.
Caldarelli M, Di Rocco C. Diagnosis of Chiari I malformation and related syringomyelia: radiological and neurophysiological studies. Child’s Nervous System [Internet]. Springer Science and Business Media LLC; 2004 Mar 18;20(5):332–5. Available from: https://doi.org/10.1007/s00381-003-0880-4
Vandertop WP, Asai A, Hoffman HJ, Drake JM, Humphreys RP, Rutka JT, et al. Surgical decompression for symptomatic Chiari II malformation in neonates with myelomeningocele. Journal of Neurosurgery [Internet]. Journal of Neurosurgery Publishing Group (JNSPG); 1992 Oct;77(4):541–4. Available from: https://doi.org/10.3171/jns.1992.77.4.0541
Schijman E, Steinbok P. International survey on the management of Chiari I malformation and syringomyelia. Child’s Nervous System [Internet]. Springer Science and Business Media LLC; 2004 May 1;20(5):341–8. Available from: https://doi.org/10.1007/s00381-003-0882-2
Pakzaban P, Pluta RM. Chiari malformation. Retrieved July. 2010;15:2011.
Nel MR, Robson V, Robinson PN. Extradural anaesthesia for caesarean section in a patient with syringomyelia and Chiari type I anomaly. British Journal of Anaesthesia [Internet]. Elsevier BV; 1998 Apr;80(4):512–5. Available from: https://doi.org/10.1093/bja/80.4.512
Ghaly R, Sauer R, Candido K, Knezevic N. Anesthetic management during Cesarean section in a woman with residual Arnold-Chiari malformation Type I, cervical kyphosis, and syringomyelia. Surgical Neurology International [Internet]. Scientific Scholar; 2012;3(1):26. Available from: https://doi.org/10.4103/2152-7806.92940
Su T-M, Lan C-M, Yang L-C, Lee T-C, Wang K-W, Hung K-S. Brain Tumor Presenting with Fatal Herniation following Delivery under Epidural Anesthesia. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Feb;96(2):508–9. Available from: https://doi.org/10.1097/00000542-200202000-00041
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