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Croatian Journal of Anaesthesiology and Intensive medicine, Vol. 1 No. 1, 2025.

Case report, case study

https://doi.org/10.66166/cjaim.1.1.8

Anesthetic Management of a Patient with Chiari Malformation Type I and Syringomyelia Undergoing Total Hip Replacement

Matea Lončar orcid id orcid.org/0009-0003-4347-0731 ; Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia *
Tihana Magdić Turković orcid id orcid.org/0000-0003-1193-512X ; Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
Goran Sabo ; Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
Filip Juroš ; Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia

* Corresponding author.

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Abstract

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.

Keywords

Arnold-Chiari malformation; syringomyelia; spinal anesthesia; total hip replacement; individualized anesthetic management

Hrčak ID:

342440

URI

https://hrcak.srce.hr/342440

Publication date:

26.12.2025.

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