Anaesthesia in patients with Arnold-Chiari-Malformation

Arnold-Chiari malformation (ACM) describes four types of hindbrain abnormal ities, of which two are relevant for anaesthesia. A review of characteristi c morphological changes and typically associated clinical symptoms is prese nted in this article. Today, neurosurgical treatment of choice is posterior fossa decompression combined with upper cervical laminectomy performed on adults with ACM type I and newborns or infants with the more pronounced ACM type II. The specific perioperative risk is increased by cardiac or respir atory autonomic neuropathies, as well as the occurrence of undetected raise d intracranial pressure. Allied abnormalities of the cranio-cervical juncti on and cervical vertebrae bear the risk of difficult endotracheal intubatio n. Surgery of ACM patients in other specialties may be performed using diff erent regional techniques, including epidural anaesthesia when the risk of general anaesthesia needs to be avoided.