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Arnold Chiari Malformation 

 

 

Background 

 

  • Group of disorders that are defined by anatomic anomalies of the cerebellum, brainstem, and craniocervical junction, with downward displacement of the cerebellum, either alone or together with the lower medulla, into the spinal canal

  • Four major types (I-IV) 

 

 

Considerations

 

  • ↑ ICP/hydrocephalus

  • C1-2 instability, dens may impinge on brainstem

  • Association with meningomyelocele:

    • Hypovolemia (fluid & blood loss from defect)

    • Infection

    • Heat loss

    • If adult: risk with neuraxial from direct injury, herniation

  • ↑ risk of latex allergy

  • ↑ perioperative risk:

    • Brainstem dysfunction: stridor, apnea, aspiration

    • Autonomic instability: arrhythmias, bradycardia, labile BP

    • Seizures 

 

 

Goals

 

  • Avoid ↑ ICP, maintain CPP

  • Avoid brainstem herniation

  • Latex-free environment

  • Rapid emergence for postoperative neurological examination

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