Maternal, Clinical, and Radiographic Outcomes: A Retrospective Analysis of Anesthesia and Delivery Modality in Chiari...

The traditional management of pregnant patients with Chiari I malformation (CM-I) heavily favors cesarean section and general anesthesia to limit the perceived risk of maternal neurological complications attributed to vaginal delivery and neuraxial anesthesia. The aim of this study was to compare reported neurological symptoms and radiographic presentations before and after childbirth performed by patients with CM-I, with and without associated syrinx.

Neurological symptoms, mode of delivery, administered anesthesia, extent of cerebellar tonsillar descent, and syrinx diameter and length were recorded before and after delivery from electronic medical records of 36 patients with CM-I who delivered between January 2008 and August 2022. Data were analyzed using paired Student t -tests.

Thirty two vaginal deliveries and 44 cesarean sections performed on 36 mothers were included. 60 deliveries used neuraxial anesthesia. Average tonsillar descent prepartum and postpartum was 9.3 ± 4.28 mm and 9.4 ± 4.81 mm, respectively ( P = .215). Average syrinx diameter prepartum and postpartum was 5.2 ± 2.72 mm and 5.2 ± 2.31 mm, respectively ( P = .611). There was no significant difference between prepartum and postpartum average tonsillar descent measurements among cesarean sections ( P = .115) or vaginal deliveries ( P = .620). There was no significant difference in syrinx diameter or length between prepartum and postpartum in cesarean section patients or in vaginal deliveries. Of the 76 deliveries, 2.6% of patients had worsened Chiari symptoms postoperatively, both are cesarean deliveries. Logistic regression demonstrated no significant worsening of Chiari-related symptoms, regardless of delivery or anesthesia type.

Our findings suggest that patients with CM-I may deliver vaginally and receive neuraxial anesthesia with low risk of neurological complications or radiographic worsening. As these patients were not prospectively selected, limitations exist, and it remains important to consider the severity of the patient's clinical and radiographic presentation when selecting anesthetic and delivery modality.