[Anaesthesia for primary cesarean section in a patient with an extensive cerebral arteriovenous malformation]

We report the case of a 37-year-old primigravida with an extreme cerebral arteriovenous malformation which displaced almost the complete left hemisphere and was inoperable. The woman had already suffered an intracerebral bleeding from this malformation many years previously. In the 26th gestational week the perfusion of the umbilical artery decreased and therefore a cesarean section became necessary. During direct measurement of arterial blood pressure an epidural catheter was inserted. Mean blood pressure always remained between 90 and 110 mmHg, the neurologic state did not deteriorate perioperatively. The mother was monitored in the intensive care unit for 24 h and was then sent back to the maternity ward in a good condition. Two months later she came back to hospital with an acute severe headache. After CT-diagnosis of an acute subarachnoid hemorrhage she underwent an emergency craniotomy.