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Management of Anesthesia and Delivery in Women With Chiari I Malformations

Waters, J.F.R.; O'Neal, M.A.; Pilato, M.; Waters, S.; Larkin, J.C.; Waters, J.H.

doi: 10.1097/01.aoa.0000557694.16118.2d
Anesthesia and Analgesia: Regional Analgesia
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(Obstet Gynecol. 2018;132:1180–1184)

A type I Chiari malformation, which is the most common type of Chiari malformation (0.6% prevalence), is defined as descent of the cerebellar tonsils below the foramen magnum by >5 mm. While most patients with this congenital malformation are asymptomatic, 30% can experience symptoms, ranging from headaches exacerbated by cough to more severe effects, such as confusion, deconjugate gaze, and papilledema as a result of increased intracranial pressure. Subsequently, there are concerns that pregnant women with Chiari I malformations may experience tonsillar herniation and neurological deterioration during vaginal delivery. In this case series, the authors assessed whether vaginal delivery or neuraxial anesthesia increased the risk of neurological deterioration in women with uncorrected Chiari I malformation.

Department of Neurology, Division of Women’s Neurology, the Department of Neurology, and the Departments of Anesthesiology and Bioengineering, McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; the Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Bioengineering, University of Pittsburgh, and the Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

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