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Anesthetic and Obstetrical Management of Patients with Arnold Chiari Malformation-I: A Multicenter Retrospective Study
Abstract Number: F2B-2
Abstract Type: Original Research
Background: Patients with Arnold Chiari Malformation-I (ACM-I) have herniation of cerebellar tonsils >5mm below the foramen magnum, posing the challenge of minimizing elevations in ICP and its subsequent neurological consequences. Consensus regarding the safest mode of delivery and anesthetic management for parturients with ACM-I remains controversial despite published reviews, case series, and algorithms for these patients and those with related syringomyelia (1-3). This study reviews the anesthetic and obstetric management of patients with ACM-I.
Methods: We conducted an IRB-approved, multicenter, retrospective, cohort study to evaluate anesthetic practices for labor analgesia and anesthesia in patients with ACM-I undergoing vaginal or cesarean delivery. Data was obtained from the electronic databases of four U.S. academic institutions using ICD codes. Study period ranged from 2007-2017 at three sites and 2004-2017 at one site. Data collected included: maternal demographics; ACM symptoms, time of diagnosis, surgical intervention prior to delivery; obstetric management and route of delivery; anesthetic management and anesthetic complications during hospitalization.
Results: Data was collected and analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147(80%) cases. Neurosurgical intervention for management of ACM-I was performed in 53(36%) patients. Preexisting symptoms were recorded for 89(48%) of the deliveries. Vaginal and cesarean deliveries occurred in 86(46%) and 99(54%) cases, respectively. Neuraxial procedures were performed for 133(72%) deliveries. Post-dural puncture headache (PDPH) was reported in 3(2%) patients who had neuraxial anesthesia. There was one reported case of aspiration pneumonia with general anesthesia.
Conclusions: Regardless of the anesthetic management or the mode of delivery, anesthetic complications were observed during postpartum hospitalization in patients with ACM-I. Obstetric and anesthetic management of such patients should still be on a case by case basis with a multidisciplinary team approach to optimize patient care.
1. C.K Choi, K. Tagaraj. Case Rep Anesthesiol. 2013; 2013:512915
2. R.F. Ghaly, T. Tverdohleb, K.D. Candido, and N.N. Knezevic. Surg Neurol Int; 2017, 8:10.
3. G.P. Garvey, V.S. Wasade, K.E. Murphy, and M. Balki. Anesth Analg; 2017, 125:3, 913-24.