Postoperative hemodynamic management in patients undergoing resection of cerebral arteriovenous malformations: A...

Strict control of blood pressure (BP) has been recommended in patients after surgical resection of cerebral arteriovenous malformations (AVM) to prevent postoperative hyperemic complication. The aim of this study was to review the postoperative hemodynamic management in patients after surgical resection of cerebral AVM and the incidence of postoperative intracranial hemorrhage and/or cerebral edema. After the ethics approval, we retrospectively reviewed the medical records of 207 adult patients who underwent elective surgical resection of cerebral AVM from Jan 2005 to Oct 2016 in a single university hospital. We determined the incidence of postoperative symptomatic intracranial hemorrhage and/or cerebral edema, and reviewed the quality of postoperative BP control during the first 72 h postoperatively. Two hundred and seven patients who underwent cerebral AVM resection were included. The median (IQR) of postoperative maximal systolic BP target was 110 (100-120) mmHg but the range was 90-150 mmHg. Failed hemodynamic control was consistently found in half of the patients during the first 72 h postoperatively. The incidence of postoperative intracranial hemorrhage and/or cerebral edema was 4.4% (9/207 patients). All 9 of these patients experienced a hypertensive event prior to their postoperative hyperemic complication. Two patients required induced hypertension to treat postoperative symptomatic cerebral edema. We concluded that postoperative intracranial hemorrhage and/or cerebral edema is not an uncommon complication after surgical resection of cerebral AVM. Further studies are required to develop a more effective strategy to implement strict BP control in the postoperative period.