Expert: Ronald Levy, M.D. - 7/5/2009

Question
Hello,

I was wondering what are the current protocols in Anesthetic options for a patient with Syringomyelia. I have Syringomyelia (currently it is T4-T9, with possibly one in the cervical region) I also have Chiari 0 malformation. This has been confirmed by Chiari Specialists, however it is being diagnosed with the traditional MRI (patient in supine)..I will do a Stand up MRI in the near future...I had a c-section April 2008 due to my son being very large (10lbs)...I did not know a lot about SM and CM at the time...nor did my OBGYN...the Anesthesiologist did ask me about my syrinx in the OR..I told him where it was although it was around T9 at the time of my C-section. Now...Is it normal to have pain at the spinal site 14mos pp? I still have pain there...it's not really bad, but annoying at times...I was recommended by the Specialist in Ny to have a C-section for my next pregnancy...Both a NL and NS told me two different things...The NL told me in the future..C-section under general...the NS told me C-section...spinal is okay..with very experienced Anesthesiologist..What have you heard your way...and would would be your recommendation in managing a particular case like this? I understand you cannot directly give me medical advice, but I like learning (Nursing Student)and want to make a wise choice in the future. Also why would an epidural be a contradiction in a patient with Syringomyelia?
Thanks
Trish

Answer
Actually both answers are correct (depending on who you listen to). There are two problems here, one is neurologic function and the other is intracranial pressure. Most anesthesiologists will avoid spinal or epidural anesthetics in patients who have spinal cord issues because, should the patient develop a deficit, there would be no way to tell if the regional was the cause. Medicolegally (and ethically) it is not a good idea to take that risk (no matter how small). The problem with ICP is that patients with SM are at risk for increased ICP. General anesthetics are more likely to cause a rise in ICP as compared to regional and this should be avoided. I have attached a link to one review of the issue

http://books.google.com/books?id=GZTs37faBqkC&pg=PA205&lpg=PA205&dq=syringomyeli...

Personally I would go with a general anesthetic if it were my patient but that is not to say that regional is inappropriate. It will depend on your anesthesiologist and their comfort level.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston