A Successful Pregnancy Outcome after Surgical Decompression of Type I Arnold-Chiari Malformation

Patricia Ip^*, Susmita Pankaja, Fidelma O’Mahony

Department of Obstetrics & Gynaecology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK.

DOI: 10.4236/ojog.2015.51007                

Abstract

Type I Arnold-Chiari malformation (ACM) usually presents in adulthood and consists of a downward displacement of the cerebellar tonsils through the foramen magnum. A 25-year-old woman presented with a 5-month history of headache associated with blurred vision, tinnitus and sickness. Imaging recognised the need for surgical intervention, but whilst awaiting for surgery she fell pregnant. Considering the risks of neurological deterioration, the woman underwent surgical decompression of type I ACM at 15 weeks gestation. She subsequently presented with progressively worsening headaches during late pregnancy from 35 weeks. The obstetric plan was initially induction of labour at term but since the onset of worsening symptoms, this date was brought forward to 39 + 1 weeks gestation. She proceeded to have a normal delivery with no neonatal complications and an uneventful puerperium followed. Since the delivery, the patient reported fewer symptoms, showed no signs of neurological deficit and a repeat magnetic resonance imaging of the head showed good relief of neural compression. This case illustrates how judicious selection of the appropriate mode of delivery of women following surgically corrected ACM and a multidisciplinary approach is critical in the successful management of the antepartum period and labour.

Keywords

Arnold-Chiari Malformation, Pregnancy, Anaesthetics

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Williams, B. (1991) Malformations. In: Swash, M. and Oxybury, J., Eds., Clinical Neurology, Churchill Livingstone, Edinburgh, 1533-1582.
[2]	Milhorat, T.H., Chou, M.W., Trinidad, E.M., Kula, R.W., Mandell, M., Wolpert, C., et al. (1999) Chiari I Malformation Redefined: Clinical and Radiographic Findings for 364 Symptomatic Patients. Neuro- surgery, 44, 1005-1017. http://dx.doi.org/10.1097/00006123-199905000-00042
[3]	Meadows, J., Kraut, M., Guarnieri, M., Haroun, R.I. and Carson, B.S. (2000) Asymptomatic Chiari Type I Malformations Identified on Magnetic Resonance Imaging. Journal of Neurosurgery, 92, 920-926. http://dx.doi.org/10.3171/jns.2000.92.6.0920
[4]	Speer, M.C., Enterline, D.S., Mehltretter, L., Hammock, P., Joseph, J., Dickerson, M., et al. (2003) Chiari Type I Malformation with or without Syringomyelia: Prevalence and Genetics. Journal of Gen- etic Counseling, 12, 297-311. http://dx.doi.org/10.1023/A:1023948921381
[5]	Ghaly, R.F., Candido, K.D., Sauer, R. and Knezevic, N.N. (2012) Anesthetic Management during Caesarean Section in a Woman with Residual Arnold-Chiari Malformation Type I, Cervical Kyphosis, and Syringomyelia. Surgical Neurology International, 3, 26. http://dx.doi.org/10.4103/2152-7806.92940
[6]	Schijman, E. (2004) History, Anatomic Forms, and Pathogenesis of Chari I Malformations. Child’s Nervous System, 20, 323-328. http://dx.doi.org/10.1007/s00381-003-0878-y
[7]	Aitken, L.A., Lindan, C.E., Sidney, S., Gupta, N., Barkovich, A.J., Sorel, M., et al. (2009) Chiari Type I Malformation in a Paediatric Population. Pediatric Neurology, 40, 449-454. http://dx.doi.org/10.1016/j.pediatrneurol.2009.01.003
[8]	Henriques Filho, P.S. and Pratesi, R. (2009) Sleep Disorder: A Possible Cause of Attention Deficit in Children and Adolescents with Chiari Malformation Type II. Arquivos de Neuro-Psiquiatria, 67, 29-34. http://dx.doi.org/10.1590/S0004-282X2009000100008
[9]	Landau, R., Giraud, R., Delrue, V. and Kern, C. (2003) Spinal Anesthesia for Cesarean Delivery in a Woman with a Surgically Corrected Type I Arnold Chiari Malformation. Anesthesia & Analgesia, 97, 253-255. http://dx.doi.org/10.1213/01.ANE.0000066312.32029.8B
[10]	Bag, T., Saha, D.P., Dutta, R., De, A.K. and Shah, A. (2012) A Successful Pregnancy Outcome after Antenatal Surgical Decompression of Arnold Chiari Malformation. The Journal of Obstetrics and Gynecology of India, 62, 13-15. http://dx.doi.org/10.1007/s13224-013-0357-7
[11]	Krysztof, M.K. (2004) Spinal Anesthesia for Cesarean Delivery in a Parturient with Arnold-Chiari Type I Malformation. Canadian Journal of Anesthesia, 51, 639. http://dx.doi.org/10.1007/BF03018412
[12]	Chantigian, R.C., Koehn, M.A., Ramin, K.D. and Warner, M.A. (2002) Chiari I Malformation in Parturients. Journal of Clinical Anesthesia, 14, 201-205. http://dx.doi.org/10.1016/S0952-8180(02)00342-2
[13]	Parker, J.D., Broberg, J.C. and Napolitano, P.G. (2002) Maternal Arnold-Chiari Type I Malformation and Syringomyelia: A Labor Management Dilemma. American Journal of Perinatology, 19, 445-450. http://dx.doi.org/10.1055/s-2002-36841
[14]	Mueller, D.M. and Oro’, J. (2005) Chiari I Malformation with or without Syringomyelia and Pregnancy: Case Studies and Review of the Literature. American Journal of Perinatology, 22, 67-70. http://dx.doi.org/10.1055/s-2005-837271
[15]	Newhouse, B.J. and Kuczkowski, K.M. (2007) Uneventful Epidural Labor Analgesia and Vaginal Delivery in a Parturient with Arnold-Chiari Malformation Type I and Sickle Cell Disease. Archives of Gynecology and Obstetrics, 275, 311-313. http://dx.doi.org/10.1007/s00404-006-0215-2
[16]	Sicuranza, G.B., Steinberg, P. and Figueroa, R. (2003) Arnold-Chiari Malformation in a Pregnant Woman. Obstetrics & Gynecology, 102, 1191-1194. http://dx.doi.org/10.1016/S0029-7844(03)00682-3