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Cervicothoracic Synringomyelia in a Parturient
Abstract Number: RF5AH-258
Abstract Type: Case Report Case Series
Syringomyelia is characterized by the formation of one or more expanding fluid-filled cavities within the spinal cord. Due to its rarity and associated neurological conditions, there is a lack of consensus regarding its anesthetic management during labor and delivery1. We present a case of a parturient with syringomyelia.
A 31 yo G2P1 with known diagnosis of cervicothoracic syringomyelia presented for obstetric anesthesia consultation at 22 weeks EGA with symptoms of upper back pain, left upper extremity paresthesia with loss of temperature sensation and intermittent left lower extremity paresthesia. In her previous pregnancy, she had a cesarean delivery at term due to failure to progress in labor. General anesthesia was performed due to the concern for neurologic symptom exacerbation with CSF and intracranial pressure fluctuations from neuraxial anesthetics. Postpartum evaluation with Neurosurgery revealed mild improvement in syrinx size on interval MRI (Fig. 1).
She was again pregnant seven months later and surgical intervention was postponed due to imaging improvement, symptom profile and risk-benefit stratification. In the interim new literature had been published supporting the safety of neuraxial anesthesia in these patients and neurosurgery agreed with this plan for her delivery2.
The patient presented at 39 3/7 weeks EGA for elective repeat cesarean delivery with plans for neuraxial anesthesia via combined spinal-epidural. Neuraxial placement was technically difficult with inadvertent intrathecal catheter placement. The catheter was dosed and utilized for delivery without intraoperative complications. Her postoperative course was complicated by a post-dural puncture headache on POD#3, which resolved with conservative therapy. The patient was discharged in stable condition without neurological symptom exacerbation on POD#4.
Due to its rare occurrence, anesthetic management of syringomyelia in the parturient remains controversial. Despite the lack of extensive literature support, neuraxial anesthetic safety has been limited only to case reports and small retrospective case series; however, no major neurologic complications have been reported1,3. As demonstrated in this case, neuraxial anesthetics were used safely without any neurologic complications, despite inadvertent intrathecal catheter placement.
1 Garvey 2017
2 Gruffi 2018
3 Teo 2018