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#Chiari malformation type 1 how to#

We Conquered Chiari: Patients and Parents Tell Their Stories.

Video Lectures: Chiari Malformation and Syringomeyelia.

Neuropsychological Treatment After Chiari Malformation.

Chiari Malformation Appointment Checklist.

#Chiari malformation type 1 how to#

How to Choose a Neurosurgeon for Chiari Malformation.

Deciding on Treatment for Chiari Malformation.

Diagnosing and Treating Chiari Malformation.

For patients with significant neurologic symptoms prior to conception, decompression prior to pregnancy should be considered.Īnesthesia Chiari malformation Neuraxial blockade Pregnancy Syringomyelia. There is no compelling reason to offer suboccipital decompression for Chiari I malformation during pregnancy. Furthermore, based on our own experience and physiological conceptual considerations, we recommend limiting maternal Valsalva efforts either via Cesarean delivery under regional or general anesthesia or by choosing assisted vaginal delivery under neuraxial blockade. Based on our survey of available data, we recommend vaginal delivery under neuraxial blockade for truly asymptomatic patients.

The available evidence is, however, rather limited. Aside from one abortion in our own institutional experience, there was no report of any therapeutic abortion or of adverse fetal outcome.Īlthough devastating maternal complications are frequently feared, very few adverse outcomes have ever been reported in pregnant patients with a Chiari I malformation. Specific data regarding maternal management were not reported for a large number (21) of these patients (60%). Several patients underwent decompressive suboccipital craniectomy to treat the Chiari I malformation during the preconception period (31%), during pregnancy (3%), and after birth (6%). Across all publications, only one patient experienced a worsening of neurologic symptoms, which was only later discovered to be the result of a previously undiagnosed Chiari I malformation. Cesarean deliveries (51%) and vaginal deliveries (49%) under neuraxial blockade and general anesthesia were both reported as safe and suitable modes of delivery. No instances of brain herniation during pregnancy in patients with Chiari I malformation were reported. Additionally, a single case from our institutional experience is presented for illustrative purposes but not included in the statistical analysis. After analysis, a total of 34 patients and 35 deliveries were included in this investigation. The English-language literature was systematically reviewed from 1991 to 2018 according to PRISMA guidelines to assess all pregnancies reported in patients with Chiari I malformation. Since the assumed potential risks are significant, we seek to systematically review published literature regarding Chiari I malformation in pregnancy and, therefore, to establish a best practice recommendation based on available evidence. Mode of delivery and planned anesthesia, therefore, require forethought to avoid potentially life-threatening complications. Labor contractions, which increase intracranial pressure, and neuraxial anesthesia both carry the theoretical risk of brainstem herniation given the altered CSF dynamics inherent to the condition. The optimal management of Chiari I malformation during pregnancy remains uncertain.