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All Journal Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
I Wayan Ade Punarbawa
Bunda Hospital
Health Professions Medicine & Pharmacology Physics

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Epidural Anesthesia for Cesarean Section in a Parturient with Chiari I Malformation: a Case Report I Wayan Ade Punarbawa; Nyoman Bendhesa Wirananggala
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/kr9sdk52

Abstract

Chiari I malformation is a congenital neurological condition characterized by caudal herniation of the cerebellar tonsils, which may alter cerebrospinal fluid dynamics and complicate anesthetic management during pregnancy. The optimal anesthetic approach for parturients with this condition remains controversial, particularly regarding the safety of neuraxial anesthesia. We report the case of a 28-year-old woman with a known Chiari I malformation who presented at term gestation and underwent an urgent cesarean section after the onset of regular uterine contractions. Preoperative neurological evaluation and imaging demonstrated stable cerebellar tonsillar herniation without syringomyelia or signs of increased intracranial pressure. Following multidisciplinary consultation, epidural anesthesia was selected to minimize abrupt cerebrospinal fluid pressure changes and maintain hemodynamic stability. Epidural anesthesia was performed using 15 mL of 0.5% plain bupivacaine, achieving a T6 sensory block level. A healthy neonate was delivered with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. The procedure was performed uneventfully, with stable intraoperative parameters and no neurological complications. Postoperative recovery was smooth, and no neurological deterioration was observed during follow-up. This case highlights that carefully planned and titrated epidural anesthesia may be a feasible anesthetic option for cesarean section in selected parturients with Chiari I malformation following thorough multidisciplinary assessment.
Epidural Anesthesia for Cesarean Section in a Parturient with Chiari I Malformation: a Case Report I Wayan Ade Punarbawa; Nyoman Bendhesa Wirananggala
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/kr9sdk52

Abstract

Chiari I malformation is a congenital neurological condition characterized by caudal herniation of the cerebellar tonsils, which may alter cerebrospinal fluid dynamics and complicate anesthetic management during pregnancy. The optimal anesthetic approach for parturients with this condition remains controversial, particularly regarding the safety of neuraxial anesthesia. We report the case of a 28-year-old woman with a known Chiari I malformation who presented at term gestation and underwent an urgent cesarean section after the onset of regular uterine contractions. Preoperative neurological evaluation and imaging demonstrated stable cerebellar tonsillar herniation without syringomyelia or signs of increased intracranial pressure. Following multidisciplinary consultation, epidural anesthesia was selected to minimize abrupt cerebrospinal fluid pressure changes and maintain hemodynamic stability. Epidural anesthesia was performed using 15 mL of 0.5% plain bupivacaine, achieving a T6 sensory block level. A healthy neonate was delivered with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. The procedure was performed uneventfully, with stable intraoperative parameters and no neurological complications. Postoperative recovery was smooth, and no neurological deterioration was observed during follow-up. This case highlights that carefully planned and titrated epidural anesthesia may be a feasible anesthetic option for cesarean section in selected parturients with Chiari I malformation following thorough multidisciplinary assessment.
Co-Authors Nyoman Bendhesa Wirananggala