Kapoor Ashie, Halling Jon
MountainView Hospital, Las Vegas, NV.
HCA Healthc J Med. 2021 Dec 29;2(6):407-410. doi: 10.36518/2689-0216.1291. eCollection 2021.
Description Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance in females. Given its relatively benign nature, CMI is often found incidentally or in adulthood when symptoms such as a headache or neck pain are present. It can be associated with syringomyelia or, less commonly, hydrocephalus. Although surgical decompression can be performed, most patients do not require surgical treatment. CMs present a unique challenge for anesthesiologists providing care to parturients. Since a majority of patients do not have a history of surgical decompression or ventriculoperitoneal shunting, it is difficult to evaluate for hydrocephalus when the patient is in labor. Therefore, many patients with diagnosed CMI are scheduled for an elective cesarean section. Numerous case reports and literature reviews have documented the successful use of spinals, epidurals and combined spinal-epidurals (CSEs) in these patients without neurologic sequelae. The patient in this case presented with CMI, which was diagnosed one year prior to our encounter, without any treatment. At the time of labor, she was asymptomatic. Although she had two prior vaginal deliveries under epidural anesthesia, she was scheduled for an elective cesarean section this time given the new diagnosis. This case report demonstrates the safe and successful use of epidural anesthesia for a parturient with CMI.
描述
Chiari畸形（CMs）是脑和颅骨的先天性缺陷，导致小脑向下移位。根据解剖缺陷的严重程度和超出枕骨大孔的脑区，CMs分为四种类型。在这些类型中，I型Chiari畸形（CMI）最不严重。其特征是小脑扁桃体向下移位超过枕骨大孔5毫米以上并进入颈椎管。CMI是最常见的类型，在普通人群中的发病率为0.1 - 0.5%，女性居多。鉴于其相对良性的性质，CMI常偶然发现或在成年出现头痛或颈部疼痛等症状时被发现。它可能与脊髓空洞症相关，或较少见地与脑积水相关。虽然可以进行手术减压，但大多数患者不需要手术治疗。CMs给为产妇提供护理的麻醉医生带来了独特的挑战。由于大多数患者没有手术减压或脑室腹腔分流的病史，在患者分娩时很难评估是否存在脑积水。因此，许多已诊断为CMI的患者计划进行择期剖宫产。大量病例报告和文献综述记录了在这些患者中成功使用脊髓麻醉、硬膜外麻醉和腰麻 - 硬膜外联合麻醉（CSE）且无神经后遗症。本病例中的患者患有CMI，在我们接诊前一年被诊断出，未接受任何治疗。分娩时，她没有症状。尽管她之前在硬膜外麻醉下有过两次阴道分娩，但鉴于新的诊断，此次计划进行择期剖宫产。本病例报告展示了对患有CMI的产妇安全且成功地使用硬膜外麻醉。
