Women diagnosed with Filum Disease, Arnold-Chiari I Syndrome and idiopathic syringomyelia frequently seek medical advice regarding the most appropriate medical recommendations for pregnancy, childbirth, and anaesthesia options during gestation.
These neurological and neurosurgical conditions can cause concern for both patients and healthcare professionals, particularly regarding potential risks during pregnancy, the safest delivery method, and the choice of anaesthesia.
Pregnancy in patients with Arnold-Chiari I, Syringomyelia and Filum Disease
In general, patients with these diagnoses require a medical evaluation prior to pregnancy to determine whether neurosurgical treatment is indicated prior to conception.
During pregnancy, follow-up should be coordinated through a multidisciplinary team – including gynecologists, anesthesiologists, neurosurgeons, and neurologists – to develop an individualized care plan that promotes both maternal and fetal well‑being.
In obstetrics, there is no single recommendation applicable to all patients regarding the type of delivery or anaesthesia. Each case must be assessed individually, taking into account the patient’s clinical status, neurosurgical history, and spinal cord anatomical characteristics.
Neurological risks during pregnancy and labor
Regarding Arnold-Chiari I Malformation, some authors highlight that:
“Pregnancy and the physiological changes of labor, pain, and hemodynamic fluctuations can affect intracranial pressure, especially in the presence of concomitant disease.”(1)
On the other hand, in Filum Disease and related conditions, as with any pathology resulting from spinal dysraphism during embryogenesis, an abnormally low level of the conus medullaris may be present, which would increase the risk of injury during neuraxial anaesthesia.
This implies an important consideration for spinal or epidural anaesthesia during labor or cesarean section.
Epidural and spinal anesthesia in patients with Filum Disease
Conditions associated with Filum Disease present a clinical challenge for anaesthesiologists treating pregnant women, as noted by various authors, due to their low incidence in the field of gynaecology and obstetrics. Consequently, there are no standardised guidelines for their management (4).
For this reason, obstetricians frequently consult with the neurologists and neurosurgeons responsible for the patient’s progress, in order to ensure comprehensive and safe care.
Caesarean section and vaginal delivery in women with Arnold-Chiari I
With regard to delivery methods, some studies indicate that:
“Many patients diagnosed with Arnold-Chiari I, but who have not undergone surgery, are scheduled for an elective caesarean section.” (3)
Based on our specialists’ experience, in patients with Filum Disease, particularly those with Arnold-Chiari I syndrome and idiopathic syringomyelia who have already had surgery according to our Filum System® method, it may be advisable to carefully assess the level of the conus medullaris before administering neuraxial anaesthesia.
The aim is for epidural or spinal anaesthesia to be administered below this level, to reduce the risk of spinal cord injury, cerebrospinal fluid fistulas and other possible complications.
Medical recommendations for pregnancy and childbirth
Every pregnancy should be approached on an individual basis. For this reason, it is recommended that pregnant patients:
- Consult all their specialists.
- Facilitate communication between gynaecologists, anaesthesiologists, neurologists and neurosurgeons.
- Provide detailed information about their neurosurgical history and clinical condition.
- Provide recent imaging studies where necessary.
Appropriate multidisciplinary care enables pregnancy and childbirth to be planned with greater assurance of safety for both mother and baby.
Referencias
- Neuraxial anaesthesia for the parturient with intracranial pathology. C. Warrick, W. Schievink and M. Zakowski. BJA Education, 25(1): 38–45 (2025).
- Pregnancy complicated by neurological and neurosurgical conditions – The evidence regarding mode of delivery. Adam Morton, Obstetric Medicine, 2022, Vol. 15(1): 11–18.
- Epidural Anesthesia for Cesarean Section for Parturient with Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report. Ashie Kapoor, MD, Jon Halling, MD. HCA Healthcare Journal of Medicine (2021) 2:6.
- Malformación de Chiari tipo I en una embarazada. Reporte de caso. Diana Marcela Hoyos-Guerrero, Rafael Leonardo Aragón Mendoza, Michel Hernández-Restrepo, Erika Andrea Alba-Romero. Ginecol Obstet Mex 2023; 91(2): 133–139.