Arnold-Chiari Tip I Malformasyonlu Gebede Anestezik Yaklaşım: Olgu Sunumu

Arnold Chiari Malformasyonu (ACM) beyin sapı ve serebellumun servikal spinal kanala doğru yer değiştirdiği konjenital bir anomalidir. ACM, baş ve ekstremite ağrıları, vertigo, hipoestezi, ekstremitelerde güçsüzlük gibi semptomlar gösterebilir. Arnold-Chiari tip I malformasyonu olan hastada sezaryende anestezik yönetim anestezist için zor bir sorun teşkil etmektedir. Ameliyatlarda, bu hastalarda intrakranial basınç önemli olup basıncın korunması yönünde tedbir alınmalıdır. İntrakranial basınçtaki artış anne ve fetüs için zararlı olabilir. Olgumuz 33 yaşında, 38 haftalık gebe olup mükerrer sezaryen için gelen ACM II hastasıdır. Nörolojik değerlendirmesinde herhangi bir defisitit yoktu. Bu olgu sunumunda biz, elektif sezaryen operasyonu planlanan ACM'lu sezaryen operasyonunda anestezi yönetimini tartışmayı amaçladık. Anahtar kelimeler: Arnold-Chiari Malformasyonu; Genel Anestezi; Gebelik.

Anahtar Kelimeler:

Arnold-Chiari Malformasyonu; Genel Anestezi; Gebelik.

Anesthesia Management For Pregnant Patient With Arnold-Chiari Malformation Type I: A Case Report

The Arnold Chiari malformation (ACM) is a congenital anomaly of the hindbrain. It is characterized by downward displacement of brains tern and cerebellum to the cervical spinal canal. ACM may show head and limb pains, vertigo, hypoesthesia, weakness in the extremities. Anesthetic management of cesarean surgery with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist Measurement of intracranial pressure at the operations in these patients is an important measure thus precautions should be taken for avoidance of increased intracranial pressure. The increase in intracranial pressure can be detrimental to the mother and fetus. The patient was a 33 years old and 38 weeks pregnant women who presented repeat cesarean surgery with ACM-II. On examination, there was no neurological deficit. In this case report, we discussed the anesthetic management of a caesarean section with ACM who underwent an elective caesarean section Key words: Arnold-Chiari Malformation; General Anesthesia; Pregnancy.

Keywords:

Arnold-Chiari Malformation; General Anesthesia; Pregnancy.,

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Penney DJ, Smallman JM. Arnold Chiari malformation and pregnancy. Int J Obstet Anesth 2001;10:139-41.
Chantigian RC, Koehn MA, Ramin KD, Warner MA. Chiari I malformation in parturients. J Clin Anesth 2002;14:201-5.
Rewari V, Singh S, Trikha A. Laparoscopic cholecystectomy in a morbidly obese patient with Chiari I malformation and craniocervical anomalies. J Clin Anesth 2008;20:372-5.
Milhorat TH, Chou MW, Trinidad EM. Chiari I malformation redefined:clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999;44:1005-7.
Ozyurt E: Sirengohidromyeli. TND Yayım Kurulu, editör. Temel Noroşirürji 1. Baskı, Ankara, 1997;1-25.
Hullander RM, Bogard TD, Leivers D. Chiari I malformation presenting as recurrent spinal headache. Anesth Analg 1992;75:1025–6.
Hilt H, Gramm H-J, Link J. Changes in intracranial pressure associated with extradural anaesthesia. Br J Anaesth 1986;58:676-80.
Landau R, Giraud R, Delrue V, Kern C. Spinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation. Anesth Analg
Turgut Özal Tıp Merkezi Dergisi 2003;97:253-5.
Jayaraman L, Sethi N, Sood J. Anaesthesia for caesarean section in a patient with lumbar syringomyelia. Revista Brasileira de Anestesiologia. 2011;61:469-73.
Ghaly RF, Candido KD, Sauer R, Knezevic NN. Anesthetic management during cesarean section in a woman with residual Arnold-Chiari malformation type I, cervical kyphosis, and syringomyelia. Surg Neurol Int J 2012;3:26.
Agustí M, Adàlia R, Fernández C, Gomar C. Anaesthesia for caesarean section in a patient with syringomyelia and Ar- nold-Chiari type I malformation. Int J Obstet Anesth 2004;13:114-6.
Karasick D, Schweitzer ME, Vaccaro AR. The traumatized cervical spine in Klippel-Feil syndrome: imaging features. Am J Roentgenol 1998;170:85-8.
Miller J, Lee C. Neurological and muscle diseases. In: Katz J, Benumof J, Kadis L B, eds, Anesthesia and Uncommon Disease, 1st editon. Philadelphia: WB Saunders; 1990, p.570- 1.