[Anesthesia and perioperative management in infants with Chiari type II malformation]

Area of Science:

• Pediatric Neurosurgery
• Neonatal Care
• Congenital Malformations

Context:

• Chiari type II malformation is a complex congenital condition often associated with hydrocephalus and myelomeningocele.
• Neonates diagnosed prenatally require multidisciplinary management, including surgical interventions.
• Respiratory compromise is a significant concern in affected infants.

Purpose:

• To report the anesthetic and postoperative management strategies for four neonates with Chiari type II malformation requiring posterior fossa decompression and cervical laminectomy.
• To highlight the potential for respiratory complications even with controlled intracranial pressure.
• To emphasize the importance of vigilant monitoring for apnea and airway compromise.

Summary:

• Fifteen neonates with Chiari type II malformation were treated between 1991 and 1997.
• Four patients underwent posterior fossa decompression and cervical laminectomy due to hindbrain decompression needs, typically between 20-87 days of life.
• These infants experienced respiratory depression, apneic spells, or swallowing difficulties, necessitating surgical intervention despite initial management for hydrocephalus and myelomeningocele.

Impact:

• This study underscores the critical need for meticulous respiratory monitoring in neonates with Chiari type II malformation, even after initial surgical correction.
• Anesthetic and surgical teams must be prepared for potential airway complications and respiratory instability.
• Early identification and management of apneic spells and vocal cord paralysis can improve outcomes for these high-risk infants.