Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

Table 1

Summary of anesthetic management of patients with Arnold-Chiari type I malformation.

Authors and references	Age; (years)	Symptoms	Tonsillar herniation (mm)	Syrinx	Surgery before labor	Gravida and para	Gestation age (wks)	Delivery method	Apgar at 1 min and 5 min	Neuraxial method	Maternal postpartum symptoms
Landau et al. [3]	31	Headache, vertigo, nausea, nystagmus, lower extremity, and hyperreflexia	Descended to C3	No	Yes	G2P1	37	CS	9, 10	Spinal	No change
	30	Arm and leg tingling	Not reported	No	No	G1P0	Not reported	CS	Not reported**	Continuous spinal	PDPH requiring blood patch
	32	Arm and leg tingling	Not reported	No	No	G2P1	Not reported	CS	Not reported**	Spinal	No change
	35	Arm and leg tingling and headache	Not reported	No	No	G3P2	Not reported	CS	Not reported**	Spinal	No change
	20	None	Undiagnosed	Undiagnosed	No	G1P0	Not reported	NSVD	Not reported**	Epidural	No change
Chantigian et al. [4]	39	Headache, right arm paresthesia, and numbness	Not reported	No	No	G3P2	Not reported	NSVD	Not reported**	Epidural	No change
	21	Headache	Not reported	No	No	G2P1	Not reported	NSVD	Not reported**	Epidural	No change
	25	None	Undiagnosed	Undiagnosed	No	G1P0	Not reported	NSVD	Not reported**	Epidural	No change
	21	None	Undiagnosed	Undiagnosed	No	G1P0	Not reported	NSVD	Not reported**	Epidural	No change
	25	None	Undiagnosed	Undiagnosed	No	G2P1	Not reported	NSVD	Not reported**	Epidural	No change
Kuczkowski [5]	35	Headache, vertigo, and upper extremity paresthesia	Not reported	No	No	G1P0	37	CS	Not reported**	Spinal	No change
Hullander et al. [6]	31	None	Undiagnosed	Undiagnosed	No	G1P0	Not reported	CS	Not reported**	Epidural and spinal	Headache and neck pain requiring blood patch
	30	Headache, dizziness, vision changes, upper extremities paresthesia, and dyspnea	8	Yes	No	G2P1	32	NSVD	Not reported*	Epidural	No change
Mueller and Oró [7]	27	Headache, tinnitus, and dizziness	4	No	Yes	G2P1	Not reported	NSVD	Not reported**	Epidural	No change
	31	Headache, blurred vision, hoarseness, dizziness, neck pain, upper extremities paresthesia, tinnitus, and dyspnea	10	No	Yes	Not reported	Not reported	NSVD	Not reported**	Epidural	No change
	32	Headache, neck pain, dizziness, hoarseness, dysphagia, and upper extremity paresthesia	13	No	Yes	G1P0	Not reported	NSVD	Not reported**	Epidural	Neck pain, spasm
Semple and McClure [8]	30	Ataxia, upper extremity paresthesia, and preeclamptic	Not reported	No	No	Not reported	30	CS	8, 9	Epidural	No change
Nel et al. [9]	31	Headache, reduced pain and temperature, and wasting on left hand	Not reported	Yes	No	G2P1	38	CS	Not reported**	Epidural	No change
Parker et al. [10]	26	Headaches, peripheral paresthesias, and weakness	Not reported	Yes	No	G1P0	38	CS	Not reported**	Epidural	No change
	30	None	Not reported	Yes	No	G1P0	39	CS	Not reported**	Epidural	No change
Newhouse and Kuczkowski [11]	20	Headache, chest pain, and hand and foot numbness	Not reported	Yes	No	G1P0	35	NSVD	8, 9	Epidural	No change
Our patient	17	Headache and neck pain	7	No	No	G1P0	39	NSVD	9, 9	CSE	No change

NSVD: normal spontaneous vaginal delivery; CS: cesarean section; CSE: combined spinal-epidural; PDPH: postdural puncture headache. *Neonate required hospitalization for pneumonia and respiratory distress. **Healthy neonate.