Arnold Chiari malformation (ACM) is defined as protrusion of the meninges and brain components into a congenital defect in the cranium or in the vertebral column. It was originally described by Austrian pathologist Hans Chiari. Among the four types, type-III ACM is the rarest and may associate with encephalocele. We report a case of type-III ACM associated with large occipitomeningoencephalocele with herniation of dysmorphic cerebellum, vermis, kinking/herniation of medulla with cerebrospinal fluid, tethering of spinal cord with posterior arch defect of C1-C3 vertebrae. The anaesthetic challenge for such patients lies in the proper preoperative work up; proper positioning of the patient during intubation; safe anaesthetic induction; intraoperative management of intracranial pressure, normothermia, and fluid and blood loss; and postoperative planning of extubation to prevent aspiration are the prerequisites to overcome the dificult airway management and anaesthetic challenge in the management of type III ACM.
Keyphrases
- type iii
- spinal cord
- patients undergoing
- cerebrospinal fluid
- end stage renal disease
- spinal cord injury
- ejection fraction
- newly diagnosed
- chronic kidney disease
- peritoneal dialysis
- intensive care unit
- cardiac surgery
- neuropathic pain
- mass spectrometry
- acute respiratory distress syndrome
- ultrasound guided
- mechanical ventilation
- optical coherence tomography
- bone mineral density
- functional connectivity
- respiratory failure
- tandem mass spectrometry