Acquired Chiari Malformation: Safety of Neuraxial Anesthesia?

Twinkal P. Dalal, Taruna Penmetcha, Maria Torres, Ramsis Ghaly

John H. Stroger Jr. Hospital of Cook County, Chicago, USA.

DOI: 10.4236/ojanes.2013.31004                

Abstract

Chiari malformation is a congenital anomaly that primarily involves the downward displacement of the cerebellar tonsils through the foramen magnum and elongation of forth ventricle and lower brainstem. Patients with Chiari I (congenital or acquired) malformation are asymptomatic or may presents with neurologic signs and symptoms. It is always a question of safety of neuraxial anesthesia in these patients. There is potential risk of dural puncture that can initiate the neurologic symptoms or worsen the existing symptoms due to CSF leakage or tonsillar herniation. Other side, performance of neuraxial anesthesia can cause acquired Chiari I type malformation due to CSF leak and intracranial hypotension. We reviewed the case reports and articles regarding safety of neuraxial anesthesia in the setting of Congenital or Acquired Chiari malformation.

Keywords

Chiari Malformation; Neuraxial Anesthesia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. M. Hullander, T. D. Bogard, D. Leivers, D. Moran and D. M. Dewan, “Chiari I Malformation Presenting as Recurrent Spinal Headache,” Anesthesia & Analgesia, Vol. 75, No. 6, 1992, pp. 1025-1026. doi:10.1213/00000539-199212000-00026
[2]	J. J. Barton and J. A. Sharpe, “Oscillopsia and Horizontal Nystagmus with Accelerating Slow Phases Following Lumbar Puncture in the Arnold-Chiari Malformation,” Annals of Neurology, Vol. 33, No. 4, 1993, pp. 418-421. doi:10.1002/ana.410330418
[3]	S. Sathi and P. E. Stieg, “Acquired Chiari I Malformation after Multiple Lumbar Punctures: Case Report,” Neurosurgery, Vol. 32, No. 2, 1993, pp. 306-309.
[4]	R. C. Chantigian, M. A. Koehn, K. D. Ramin and M. A. Warner, “Chiari I Malformation in Parturients,” Journal of Clinical Anesthesia, Vol. 14, No. 3, 2002, pp. 201-205. doi:10.1016/S0952-8180(02)00342-2
[5]	C. Margarido, R. Mikhael, A. Salman and M. Balki, “Epidural Anesthesia for Cesarean Delivery in a Patient with Post-Traumatic Cervical Syringomyelia,” Canadian Journal of Anesthesia, Vol. 58, No. 8, pp. 764-768. doi:10.1007/s12630-011-9525-3
[6]	J. L. Atkinson, B. G. Weinshenker, G. M. Miller, D. G. Piepgras and B. Mokri, “Acquired Chiari I Malformation Secondary to Spontaneous Spinal Cerebrospinal Fluid Leakage and Chronic Intracranial Hypotension Syndrome in Seven Cases,” Journal of Neurosurgery, Vol. 88, No. 2, 1998, pp. 237-242. doi:10.3171/jns.1998.88.2.0237
[7]	P. G. Kranz, R. J. Viola and L. Gray, “Resolution of Syringohydromyelia with Targeted CT-Guided Epidural Blood Patching,” Journal of Neurosurgery, Vol. 115, No. 3, pp. 641-644. doi:10.3171/2011.3.JNS102164