Abstract:
BACKGROUND:The optimal management of Chiari I malformation during pregnancy remains uncertain. Labor contractions, which increase intracranial pressure, and neuraxial anesthesia both carry the theoretical risk of brainstem herniation given the altered CSF dynamics inherent to the condition. Mode of delivery and planned anesthesia, therefore, require forethought to avoid potentially life-threatening complications. Since the assumed potential risks are significant, we seek to systematically review published literature regarding Chiari I malformation in pregnancy and, therefore, to establish a best practice recommendation based on available evidence. METHODS:The English-language literature was systematically reviewed from 1991 to 2018 according to PRISMA guidelines to assess all pregnancies reported in patients with Chiari I malformation. After analysis, a total of 34 patients and 35 deliveries were included in this investigation. Additionally, a single case from our institutional experience is presented for illustrative purposes but not included in the statistical analysis. RESULTS:No instances of brain herniation during pregnancy in patients with Chiari I malformation were reported. Cesarean deliveries (51%) and vaginal deliveries (49%) under neuraxial blockade and general anesthesia were both reported as safe and suitable modes of delivery. Across all publications, only one patient experienced a worsening of neurologic symptoms, which was only later discovered to be the result of a previously undiagnosed Chiari I malformation. Several patients underwent decompressive suboccipital craniectomy to treat the Chiari I malformation during the preconception period (31%), during pregnancy (3%), and after birth (6%). Specific data regarding maternal management were not reported for a large number (21) of these patients (60%). Aside from one abortion in our own institutional experience, there was no report of any therapeutic abortion or of adverse fetal outcome. CONCLUSIONS:Although devastating maternal complications are frequently feared, very few adverse outcomes have ever been reported in pregnant patients with a Chiari I malformation. The available evidence is, however, rather limited. Based on our survey of available data, we recommend vaginal delivery under neuraxial blockade for truly asymptomatic patients. Furthermore, based on our own experience and physiological conceptual considerations, we recommend limiting maternal Valsalva efforts either via Cesarean delivery under regional or general anesthesia or by choosing assisted vaginal delivery under neuraxial blockade. There is no compelling reason to offer suboccipital decompression for Chiari I malformation during pregnancy. For patients with significant neurologic symptoms prior to conception, decompression prior to pregnancy should be considered.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Sastry R,Sufianov R,Laviv Y,Young BC,Rojas R,Bhadelia R,Boone MD,Kasper EMdoi
10.1007/s00701-020-04308-7subject
Has Abstractpub_date
2020-07-01 00:00:00pages
1565-1573issue
7eissn
0001-6268issn
0942-0940pii
10.1007/s00701-020-04308-7journal_volume
162pub_type
杂志文章abstract:BACKGROUND:The understanding of molecular alterations of tumors has severely changed the concept of classification in all fields of pathology. The availability of high-throughput technologies such as next-generation sequencing allows for a much more precise definition of tumor entities. Also in the field of brain tumor...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s00701-016-3062-3
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Ganglioglioma is a common seizure-associated tumor, and some factors that may influence the postoperative seizure outcome have not been discussed or are controversial. The goal of this study was to observe the postoperative seizure outcome and the prognostic factors in patients with epileptogenic ganglioglio...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-011-1259-z
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Trigeminal neuralgia (TN) is primarily diagnosed by symptoms and patient history. Magnetic resonance (MR) imaging can be helpful in visualizing the neurovascular compression of the trigeminal nerve in TN patients, but the current parameters used as diagnostic markers for TN are less than optimal. The aim of ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-012-1327-z
更新日期:2012-09-01 00:00:00
abstract::To understand the clinicopathology features of leptomeningeal dissemination of malignant gliomas, a total of 157 consecutive patients treated between 1978 and 1989 were analysed. Twenty-two patients (14%) were judged to have dissemination. In 20 patients, the dissemination was diagnosed antemortem. Eleven patients had...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01476415
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Accumulating results have disclosed that early brain injury (EBI) may play a major role in the determination of the outcome of aneurysmal subarachnoid hemorrhage (SAH) patients. This study is of interest to examine the efficacy of pitavastatin, a 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase) ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-015-2399-3
更新日期:2015-06-01 00:00:00
abstract::The levels of circulating immune complexes (CIC) were assayed in the sera of 109 patients with intracranial space occupying lesions. The CIC levels were significantly increased in all the brain tumours. After treatment, the CIC levels were still significantly increased when compared to the controls but showed no chang...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01420068
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:In an increasingly complex and competitive professional environment, improving methods to educate neurosurgical residents is key to ensure high-quality patient care. Electronic (e)Learning resources promise interactive knowledge acquisition. We set out to give a comprehensive overview on available eLearning ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,meta分析
doi:10.1007/s00701-016-3042-7
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:An understanding of the present standing of surgery, surgical results and the role in altering the future morbidity and mortality of untreated brain arteriovenous malformations (bAVMs) is appropriate considering the myriad alternative management pathways (including radiosurgery, embolization or some combinat...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s00701-017-3217-x
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Intravenous recombinant tissue-type plasminogen activator (rt-PA) with/without endovascular treatment is not as effective in atherosclerotic steno-occlusive acute ischemic stroke. Urgent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is effective to some extent in progressing stroke...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s00701-018-3576-y
更新日期:2018-09-01 00:00:00
abstract::A review is made of the current management strategies of abscesses in basal ganglia and thalamus, based on a review of the literature and three of our own cases. Clinical picture, aetiology, diagnostic, surgical treatment and outcome are discussed. Stereotactic abscess puncture in combination with temporary drainage a...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/BF01808554
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Multicentric WHO grade II gliomas constitute a rare entity. Their pathogenesis and treatment are still a matter of debate. OBJECTIVE:We present a 23 year-old female with two synchronous but separate WHO grade II oligodendrogliomas in the temporal and frontal lobes. CLINICAL FEATURES:The two lesions showed ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-009-0306-5
更新日期:2009-12-01 00:00:00
abstract:INTRODUCTION:Intraoperative MRI (iMRI) has been established as a routine imaging modality with a remarkable impact on specific neurosurgical procedures. The technological advancement continuously extends the spectrum of iMRI, leading to an increasing number of installations. Yet, procedures in which a semi-sitting posi...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-010-0607-8
更新日期:2010-06-01 00:00:00
abstract::On the basis of a series of 75 patients, the practical use of Icp continuous long-term recording in severe head injuries without mass lesions or remaining deeply comatose after surgical procedures is critically analyzed. ICP monitoring alone seems to be not essential for prognosis. Conversely it is of much greater use...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01406729
更新日期:1977-01-01 00:00:00
abstract:BACKGROUND:Circumferential intradural spinal meningiomas are exceptionally rare. They pose several surgical challenges and a complete excision is not easy. The aim of this study is to provide surgical strategies to facilitate a full excision of such tumors. METHODS:A fully circumferential intradural meningioma at T9/1...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-017-3354-2
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Complex aneurysm shape is a predominant risk factor for aneurysm rupture but its impact on clinical outcome after clipping remains unclear. The objective of the present study was to compare complications and morbidity after clipping of unruptured single-sac aneurysms (SSAs) and aneurysms with multiple sacs (...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-018-3675-9
更新日期:2018-11-01 00:00:00
abstract::Eosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It's often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans' cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontane...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-003-0182-3
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVES:A number of different image-guided surgical techniques have been developed during the past decade. None of these methods can provide the surgeon with information about the dynamic changes that occur intra-operatively. MATERIAL AND METHOD:The first vertical open 0.5T MRI-scanner for intra-operative MRI-guide...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010050325
更新日期:1999-01-01 00:00:00
abstract:INTRODUCTION:Gamma knife radiosurgery (GKRS) has for the last decades been an established treatment option for patients with small- or medium-sized vestibular schwannomas (VS), although little data is reported on long-term outcome regarding quality of life (QOL) and tumour control in this patient category. The objectiv...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-013-1924-5
更新日期:2014-02-01 00:00:00
abstract::A method is described for monitoring the relationship between CSF pulse pressure and ICP in clinical patients. Highly significant linear relationships were found during 65 continuous ICP recordings in 58 patients. The slope value of this relationship showed a positive correlation with the elastance coefficient, a volu...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01403461
更新日期:1986-01-01 00:00:00
abstract::An experience with surgical management of 30 giant pituitary tumours is analysed in this report. The clinical features, anatomical spread and relationship of these tumours with the cavernous sinus and other parasellar and basal forebrain structures is analysed. The problem encountered in the surgical treatment are rev...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01412306
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:The placement of intervertebral cages in anterior cervical discectomy (ACDF) supposedly maintains foraminal height. The most commonly reported cage-related complication is subsidence, although it is unknown whether a correlation between subsidence and clinical outcome exists. AIM:To assess the incidence and...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-018-3490-3
更新日期:2018-04-01 00:00:00
abstract:STUDY DESIGN:Retrospective analysis of 357 cases of degenerative disc disease treated by interbody fusion with threaded titanium cages. OBJECTIVE:To determine the safety and efficiency of cervical and lumbar interbody fusions using threaded titanium cages and autogenous bone. SUMMARY OF BACKGROUND DATA:Stabilizing th...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010050453
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic. METHODS:In this observational, longitudinal coh...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04437-z
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Meticulous haemostasis is one of the most important factors during microneurosurgical resection of brain arteriovenous malformation (AVM). Controlling major arterial feeders and draining veins with clips and bipolar coagulation are well-established techniques, while managing with bleeding from deep tiny vess...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-017-3138-8
更新日期:2017-05-01 00:00:00
abstract::Radiosurgery is either a primary or an adjunctive management approach used to treat patients with vestibular schwannomas. We sought to determine outcomes measuring the potential benefits against the neurological risks in patients who underwent radiosurgery after previous microsurgical subtotal resection or recurrence ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-002-0950-5
更新日期:2002-07-01 00:00:00
abstract::The monoclonal antibody Ki-67 has been tested as a marker of proliferating cells in 52 stereotactic brain tumour biopsies. The antibody reacts with a nuclear protein expressed in G1,S, G2n and M-phases of the cell cycle. Using the immunoperoxidase technique on squash preparations the percentage of Ki-67 positive cells...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01560376
更新日期:1987-01-01 00:00:00
abstract:BACKGROUND:We verified the effectiveness of training in endoscopic endonasal transsphenoidal surgery (eETSS) techniques using chicken eggs and a skull model. METHODS:We verified the area of eggshell removed by drilling when five residents and four experts used the chicken eggs and a skull model. RESULTS:When resident...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-014-2035-7
更新日期:2014-07-01 00:00:00
abstract::The results of 16 cases of temporal bone resection were evaluated. The resections, 12 of which were total and 4 partial, had mostly been performed for squamous cell carcinoma invading the temporal bone. Five patients in whom the intervention was considered radical and not followed by irradiation, were alive and well 9...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01400676
更新日期:1991-01-01 00:00:00
abstract::The clinical findings and operation results in two series of patients with medial prolapse of an intervertebral disc with total or partial occlusion of the spinal canal are reported. In one of the series (30 patients) symptoms of cauda equina compression, with bladder and rectal disturbances, were present, and in the ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01405333
更新日期:1978-01-01 00:00:00
abstract::During follow-up of 485 adult patients with mainly mild head injury 27% of the patients were unemployed after an observation period of 3-5 years (mean 4.0 years). The length of sick leave during the last 3 years was longer than for a control group. Reduced physical capacity and time of sick leave during the last 3 yea...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01402368
更新日期:1987-01-01 00:00:00