Anesthetic Management of a Patient with Chiari Malformation Type I and Syringomyelia Undergoing Total Hip Replacement
Keywords:
acute kidney injury (AKI), aneurysmatic subarachnoid haemorrhage, uremic coma, renal replacement therapyAbstract
Syringomyelia associated with Chiari malformation type I presents significant anesthetic challenges due to risks related to altered cerebrospinal fluid dynamics, autonomic dysfunction, impaired respiratory function, and potential for increased intracranial pressure. Evidence-based recommendations remain limited, particularly for non-obstetric procedures. We report the successful anesthetic management of a 52-year-old male with Chiari malformation type I and cervicothoracic syringomyelia undergoing elective total hip arthroplasty. Given prior posterior fossa decompression, thoracic kyphoscoliosis, and concern for increased intracranial pressure during airway manipulation, spinal anesthesia was selected. The procedure and postoperative recovery were uneventful, with stable hemodynamics and no neurological deterioration. This case supports the growing view that neuraxial anesthesia can be safely performed in selected patients with syringomyelia and Chiari malformation type I when there is no radiological evidence of elevated intracranial pressure or syrinx extension at the puncture site. Individualized anesthetic planning, multidisciplinary collaboration, and meticulous intraoperative monitoring are key to optimizing outcomes in non-obstetric surgery.
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