TITLE:
Acquired Chiari Malformation: Safety of Neuraxial Anesthesia?
AUTHORS:
Twinkal P. Dalal, Taruna Penmetcha, Maria Torres, Ramsis Ghaly
KEYWORDS:
Chiari Malformation; Neuraxial Anesthesia
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.1,
January
31,
2013
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.