Background

Chiari malformation type 1 (CM-I), is defined as a congenital

Results

Nine patients ranging from ages 22-44 years old (mean age of 33)

herniation of the cerebellar tonsils caudally through the foramen magnum with displacement of the pons and medulla.1 Increased brain turgor due to the malformation may occur, which can interfere with cerebrospinal fluid (CSF) absorption and lead to increased intracranial pressure.2 This can be especially concerning in pregnant patients undergoing labor, where increases in intracranial pressure during labor could potentially result in tonsillar herniation.3 Because of these concerns, administering an epidural can be risky due to possible rupture of the dura and subsequent herniation in CM- 1 patients.4 We present a case series on patients with Chiari malformation undergoing neuraxial anesthesia

Methods

Following the IRB approval to assemble this case series, electronic record databases were used to identify female patients under the age of 50 with Chiari I malformation who had been admitted to the UTMB hospital system. Patients who had delivered, vaginally or via C-section, and had undergone neuraxial analgesia were included in the study. Data on the patients’ age, mode of delivery, type of analgesia, types of anesthetic medications used for analgesia, neurologic symptoms, and other symptoms/complications were collected.

Demographic Data

Results

were included in this case series. Data set included eight Caucasian/White patients and one African American/Black patient. The most common symptoms experienced by these patients were headaches. One patient experienced syncope and sciatica along with their headaches. Another patient experienced headaches and seizures. A third patient experienced visual disturbances, nausea, and vomiting as well. Six out of seven patients tolerated epidural anesthesia. The seventh patient received pudendal nerve blocks and received intravenous opioids for analgesia.