Chiari II malformation may lead to the requirement of which procedures?

• A. Tracheostomy or gastrostomy
• B. VP shunt
• C. Lumbar puncture
• D. Endoscopic third ventriculostomy

Answer: (A)

Chiari II malformation can involve brainstem structures to a degree that impairs airway protection and swallowing. When this leads to persistent breathing difficulties or unsafe feeding, long-term airway support and feeding access may be needed. A tracheostomy provides a secure airway for sustained ventilation and protection, while a gastrostomy tube offers reliable nutrition when oral feeding is challenging or unsafe.

While hydrocephalus often accompanies Chiari II and is commonly treated with a VP shunt, the scenario described focuses on issues arising from airway and feeding difficulties rather than hydrocephalus management. Lumbar puncture isn’t a treatment for the complications associated with Chiari II, and endoscopic third ventriculostomy is a hydrocephalus-directed procedure that isn’t specifically indicated for airway or feeding needs in this context.