Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

Abstract

Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study

“…In 2013, Choi and Tyagaraj published a review of the literature on neuraxial anesthesia techniques for parturients with ACM-I and a case report of a patient who received a CSE technique for labor analgesia without complication. 19 The review included 22 patients who did not have worsening ACM-related neurological symptoms, but it did not include patients who received general anesthesia. A case series presented by Chantigian et al in 2002 included both neuraxial (nine patients) and general anesthetic techniques (three patients).…”

“…[7][8][9] General anesthesia with laryngoscopy and tracheal intubation may also increase ICP or the CSF pressure gradient. 4 Since no prospective randomized trial is likely to be conducted for practical reasons, the majority of the literature regarding anesthetic management of parturients with ACM-I is case reports and smaller case series, [10][11][12][13][14][15][16][17][18][19] literature reviews, 3,19,20 and algorithms. 4,21 The purpose of this study was to conduct a larger review of the anesthetic management and related complications of parturients with ACM-I who had undergone vaginal or cesarean delivery at four academic medical centers in the United States (US).…”

Anesthesia Experience Of A Pediatric Patient With Arnold Chiari Type I Malformation

“…A retrospective study of pregnant women with syringomyelia reports that general and neuraxial anesthesia can be successfully performed without major long-term complications (7). Unintentional dural puncture with epidural needle may lead to tentorial herniation, decreased perfusion pressure and herniation (8). The same complication may also occur with spinal anesthesia but the severity and frequency of dural puncture due to spinal needle size is less than epidural anesthesia.…”

Rare neurological diseases and pregnancy

“…Анестезия при родоразрешении. Большинство авторов считают, что родоразрешение под общей или региональной анестезией не ухудшает состояние пациенток с сирингомиелией [48].…”