Arteriovenous malformation, complications, and perioperative anesthetic management

Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation, with an estimated occurrence of 1:5000-1:2000 persons. The repair requires careful embolization, often followed by stereotactic radiosurgery and can also include open craniotomy. Preoperatively, patients may be healthy or dramatically unstable, as 30-50% of these cases present with acute cerebral hemorrhage. One of the most important considerations for the anesthesiologist should be attempting to achieve hemodynamic stability in the face of potential increased intracranial pressure and subsequent vulnerability of the tissues to ischemic insult. Knowledge of the risks and hazards of the procedure and collaboration with specialists, including neuroradiologists, critical care physicians, and potentially neurosurgeons, ultimately form the basis for appropriate management. AVM's can lead to potentially fatal ischemic or hemorrhagic complications that may occur in up to 8% of cases. The protection of the airway, adequate monitoring, and maintaining cardiovascular and neurological stability, are critical. Further, in the setting of a radiological suite, peripheral location considerations involving equipment, monitors, and appropriate drugs and sustaining the patient's immobility during the radiological procedures, while managing potential perioperative complications are all essential.