Abstract
We describe a patient with severe Arnold Chiari Malformation and syringomyelia who underwent gynecological laparoscopy in an emergency context; no brain imaging was available. We here report the successful use of optic nerve sheath diameter (ONSD) and middle cerebral artery (MCA) velocity measurements as surrogate monitoring for cerebral blood flow and intracranial pressure, respectively. MCA velocity was low when assessed after peritoneal insufflation and ONSD increased to 6.3 mm after Trendelenburg positioning. This noninvasive Ultrasound and Doppler neurological monitoring helped adapt the anesthetic management and the patient recovered both normal ONSD and MCA velocity values.