Anesthetic management for cerebral arteriovenous malformation surgery

• A male patient with atrial myxoma and multiple metastatic intracranial aneurysms: A case report and literature review
• Ultrasound-guided transuterine coil embolization of a Vein of Galen malformation
• Right Ventricular Myxoma Presenting in a Patient With Known Arteriovenous Malformations in the Brain: A Case Report
• Use of near infrared spectroscopy for the prediction of perioperative complications in patients undergoing elective microsurgical resection of cerebral arteriovenous malformations- a prospective observational trial (NIRSCAM trial)
• Management and outcome predictors of patients with ruptured deep-seated brain arteriovenous malformations
• Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series
• Safety and Effectiveness of First-line Endovascular Management of Low-Grade Brain Arteriovenous Malformations : Single Center Experience in 145 Patients
• Microsurgical Treatment of Deep and Eloquent AVMs

There is no clear consensus guidance for anesthesiologists for cerebral arteriovenous malformation rupture and hemorrhage during pregnancy who need craniotomy.

Ji et al. reviewed the anesthesia management of pregnant women who underwent cerebral arteriovenous malformation surgery at the institution and provided opinions and suggestions.

They report 3 patients with cAVM rupture and hemorrhage during pregnancy who underwent neurosurgery at the 22nd, 28th, and 20th weeks of pregnancy.

All 3 patients were admitted to the emergency department of the hospital due to sudden symptoms. Subsequently, their head imaging results confirmed the rupture and hemorrhage of cAVM. The rupture and hemorrhage of cAVM during pregnancy have a low incidence and high mortality, which seriously endangers the safety of the mother and fetus. For this emergency condition, craniotomy for removing intracranial lesions and clear hematoma can result in a chance of successful delivery. Especially in the second and third trimesters of pregnancy, the management goal of anesthesia is to ensure maternofetal safety and to maintain continuous pregnancy.

Resection of intracranial lesions should be performed whenever possible while maintaining the pregnancy for better maternal and infant outcomes.

The operations of the 3 pregnant women were successfully completed under our detailed anesthesia planning and careful anesthesia management. All the patients recovered well after the operation and underwent cesarean section to give birth smoothly.

Lessons: The preservation of pregnancy under cAVM resection is a complex challenge for anesthesiologists, and these 3 cases provide an extensive amount of experience for anesthesia management in similar situations. Detailed anesthesia planning and careful anesthesia management by anesthesiologists are important guarantees for good maternal and fetal outcomes ¹⁾.