Spence, Samantha Rose

12y · Female·Raised intracranial pressure due to acute-on-chronic hydrocephalus in the context of surgically treated scoliosis, with Chiari type 1 malformation as a significant contributing condition

Samantha Rose Spence, 12 years old, died two days after spinal fusion surgery for severe scoliosis. She had a pre-existing, asymptomatic Chiari type 1 malformation detected on pre-operative MRI of her spine. A paediatric neurologist assessed her as cleared for surgery. Post-operatively, she developed acute-on-chronic hydrocephalus with raised intracranial pressure, causing sudden respiratory arrest and death. Clinical lessons include: pre-operative brain imaging should be performed in children with Chiari malformations to identify asymptomatic chronic hydrocephalus; family concerns about patient deterioration must be taken seriously and escalated promptly; comprehensive handover procedures from ICU to ward are critical; and clinicians must maintain awareness of Chiari malformation as a risk factor during perioperative management.