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Published on: November 30, 2012
Pediatric neuroanesthesia. Arteriovenous malformations
1Department of Anesthesiology, California Pacific Medical Center, San Francisco, California, USA.
Insights
Intracranial arteriovenous malformations (AVMs) present with hemorrhage or seizures. Treatment options include microsurgery, embolization, and radiosurgery, with anesthesia management crucial for preventing rupture.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Intracranial arteriovenous malformations (AVMs) are complex vascular lesions.
- They can occur as single or multiple lesions, sometimes associated with aneurysms or connective-tissue disorders.
- Intracranial hemorrhage is the most common presentation (20-50%), followed by seizures in children (15-20%).
Purpose of the Study:
- To outline the clinical presentation and treatment modalities for intracranial AVMs.
- To emphasize the importance of anesthetic management in patients with AVMs and intracranial hematomas.
Main Methods:
- Review of treatment options for intracranial AVMs.
- Discussion of anesthetic considerations during diagnostic and therapeutic procedures.
Main Results:
- Available treatments include microsurgery, embolization, and stereotactic radiosurgery (e.g., alpha knife, linear accelerator).
- Anesthesia aims to prevent AVM/aneurysm rupture and manage intracranial compliance during procedures like CT and MR scanning.
Conclusions:
- Intracranial AVMs require a multidisciplinary approach involving various treatment modalities.
- Careful anesthetic management is essential for improving outcomes and preventing complications in patients with intracranial AVMs.
Abstract:
Intracranial arteriovenous malformations can occur singly, multiply, and in conjunction with aneurysms and denovo, family, or in conjunction with connective-tissue disorders. Intracranial hemorrhage is the most common presentation, occurring in 20% to 50% of cases. In children, seizures are the second most common presentation occurring in 15% to 20% of cases. The modalities available treatment of arteriovenous malformations are microsurgery, embolization, and stereotactic radiosurgery with heavy particles, alpha knife, or linear accelerator. Induction, maintenance, and emergence from anesthesia are designed to prevent rupture of arteriovenous malformation and aneurysm and to improve intracranial compliance in the presence of an intracranial hematoma, during both diagnostic (CT, MR scanning) and therapeutic procedures.
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