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Review
. 2021 Apr 1;21(1):272.
doi: 10.1186/s12884-021-03751-3.

Anesthetic management for cesarean delivery in a woman with congenital atlantoaxial dislocation and Chiari type I anomaly: a case report and literature review

Yuyan Nie #  1 , Weimin Zhou #  2 , Shaoqiang Huang  3
Affiliations
Review

Anesthetic management for cesarean delivery in a woman with congenital atlantoaxial dislocation and Chiari type I anomaly: a case report and literature review

Yuyan Nie et al. BMC Pregnancy Childbirth. .

Abstract

Background: The preferable choice of anesthesia for the patients with congenital atlantoaxial dislocation (CAAD) and type I Arnold Chiari malformations (ACM-I) has been a very confusing issue in clinical practice. We describe the successful administration of combined spinal-epidural anesthesia for a woman with CAAD and ACM-1 accompanied by syringomyelia.

Case presentation: Our case report presents the successful management of a challenging obstetric patient with CAAD and ACM-1 accompanied by syringomyelia. She had high risks of difficult airway and aspiration. The injection of bolus drugs through the spinal or epidural needle may worsen the previous neurological complications. The patient was well evaluated with a multidisciplinary technique before surgery and the anesthesia was provided by a skilled anesthesiologist with slow spinal injection.

Conclusions: An interdisciplinary team approach is needed to weigh risks and benefits for patients with CAAD and ACM-1 undergoing cesarean delivery. Therefore, an individual anesthetic plan should be made basing on the available anesthetic equipments and physicians' clinical experience on anesthetic techniques.

Keywords: Anesthetic management; Cesarean section; Congenital atlantoaxial dislocation Arnold–Chiari malformation; Syringomyelia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
T2-weighted sagittal MRI of the upper spinal cord and brainstem in a pregnant woman with Congenital Atlantoaxial Dislocation and Chiari type I anomaly accompanied by syringomyelia. The syrinx is indicated from C2 to T 9 (black arrows). The cerebellar tonsil herniates through the foramen magnum (white arrow)
Fig. 2
Fig. 2
Computed Tomography demonstrates that the odontoid of the axis protrudes into the skull (black arrow). Multiple cervical vertebrae deformity and fusion are also seen (white arrows)
See this image and copyright information in PMC

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