Anaesthetic Challenges and Perioperative Management of Arnold Chiari Malformation Type 1: A Case Report

Abstract

Arnold Chiari Malformation (ACM) is a group of deformities of the cranium and hindbrain, where there is herniation of cerebellar tonsils through the foramen magnum. Based on the morphology and degree of anatomic defects, Chiari malformations are categorised as type 1, 2, and 3, usually through imaging. While type 2 and 3 are more prevalent and occur in younger age groups, being present from birth, type 1 Chiari is the least severe and is more frequently found in adults. Numerous deformities, including spinal deformity, encephalocele, hydrocephalus, syrinx, and elevated intracranial pressure, are associated with it. Additionally, there are autonomic disturbances associated with it as well. As a result of all these factors, anaesthesiologists face significant challenges. Hereby, the authors present a case report of 52-year-old male patient of ACM type 1 associated with bony deformity at the craniovertebral junction and syrinx, who underwent cervical decompression with C1-C2 fixation. This patient had a tingling sensation and numbness in the left upper limb, with power in the left upper limb being 1/5 and progressive gait abnormalities. Additionally, the present patient had his right upper limb amputated below the elbow joint after a road traffic accident 10 years ago, which imposed more challenges regarding intravenous access. A well-thought-out, multidisciplinary approach is needed for its management. The management of adequate intraoperative anaesthesia in such cases will have an impact on the recovery after surgery of patients with ACM type 1.

Keywords

• congenital abnormality
• difficult airway
• neuroanaesthesia