Department of Neurosurgery, CRMR C-MAVEM, Bicêtre Hospital, AP-HP, France; Department of Anesthesiology and Intensive Care, Bicêtre Hospital, AP-HP, France.
Department of Anesthesiology and Intensive Care, Bicêtre Hospital, AP-HP, France; University Paris-Sud Medical School, Paris-Saclay University, France.
J Gynecol Obstet Hum Reprod. 2021 Mar;50(3):101970. doi: 10.1016/j.jogoh.2020.101970. Epub 2020 Nov 4.
Although a recurrent question in clinical practice, the management of Chiari malformation type I (CMI) and/or syringomyelia during pregnancy and delivery is still debated. The aim of this study was to investigate the modalities of delivery and anesthesia in women presenting with CMI and/or syringomyelia at a national reference center, and to question their potential role in the natural history of these conditions.
We conducted a retrospective cohort study using a standardized questionnaire, a customized clinical severity score and data from medical records.
83 patients were included in the final analysis: 32 had CMI without syringomyelia, 27 had CMI with syringomyelia and 24 had non-foraminal syringomyelia. Most patients (55/83) were not diagnosed at the time of their pregnancy, 12 had surgery before being pregnant and 16 were diagnosed but not operated. Most women underwent vaginal delivery (62 %) and neuraxial (i.e. epidural or spinal) anesthesia (69 %). However, the proportion of cesarean procedures increased to 53.6 % and even 83.3 % when considering only patients already diagnosed or operated on, respectively. Nonetheless, neither vaginal compared to cesarean delivery (change in clinically severity score: -1.5 ± 0.4 versus -0.9 ± 0.4, p = 0.4) nor neuraxial compared to general anesthesia (-1.2 ± 0.3 versus -1.5 ± 0.6, p = 0.7) were associated with increased clinical deterioration.
Although individual evaluation is mandatory, this study supports that neither delivery nor anesthesia modalities affect the natural history for the vast majority of patients with CMI and/or syringomyelia.
尽管在临床实践中经常出现这个问题，但 Chiari 畸形 I 型（CMI）和/或脊髓空洞症在妊娠和分娩期间的处理仍存在争议。本研究的目的是调查在国家参考中心就诊的 CMI 和/或脊髓空洞症患者的分娩和麻醉方式，并探讨这些方式在这些疾病自然史中的潜在作用。
我们使用标准化问卷、定制的临床严重程度评分和病历数据进行了回顾性队列研究。
最终分析纳入了 83 例患者：32 例无脊髓空洞症的 CMI 患者，27 例有脊髓空洞症的 CMI 患者和 24 例非孔源性脊髓空洞症患者。大多数患者（55/83）在妊娠时未被诊断，12 例患者在妊娠前接受了手术，16 例患者被诊断但未接受手术。大多数女性接受了阴道分娩（62%）和椎管内（即硬膜外或脊髓）麻醉（69%）。然而，仅考虑已经诊断或已经手术的患者时，剖宫产的比例增加到 53.6%，甚至增加到 83.3%。然而，阴道分娩与剖宫产（临床严重程度评分变化：-1.5 ± 0.4 与-0.9 ± 0.4，p = 0.4）或椎管内麻醉与全身麻醉（-1.2 ± 0.3 与-1.5 ± 0.6，p = 0.7）相比，均与临床恶化无关。
尽管需要进行个体化评估，但本研究支持对于绝大多数 CMI 和/或脊髓空洞症患者，分娩方式和麻醉方式均不会影响其自然史。
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