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Published on: May 9, 2013
Anaesthesia for cerebral arteriovenous malformations in children
Insights
This study reviewed 50 cerebral arteriovenous malformation (AVM) surgeries in children. Anesthetic management, including controlled hypotension, was found to be safe and effective, with no intraoperative deaths.
Area of Science:
- Neurosurgery
- Pediatric Anesthesiology
- Vascular Neurology
Background:
- Cerebral arteriovenous malformations (AVMs) pose significant surgical challenges, particularly in pediatric populations.
- Intracranial hemorrhage is a common presentation of pediatric AVMs, often necessitating urgent surgical intervention.
- Effective anesthetic management is crucial for optimizing surgical conditions and patient outcomes during AVM resection.
Purpose of the Study:
- To analyze the anesthetic management and surgical outcomes of pediatric patients undergoing craniotomy for cerebral AVMs.
- To evaluate the safety and efficacy of controlled hypotension during AVM excision in children.
- To describe the current anesthetic practices for pediatric AVM surgery at a major children's hospital.
Main Methods:
- Retrospective review of 50 craniotomies for cerebral AVMs performed between 1966 and 1982.
- Detailed analysis of anesthetic techniques, including induction, maintenance, ventilation, and the use of controlled hypotension.
- Assessment of intraoperative blood loss, surgical duration, and patient outcomes.
Main Results:
- No intraoperative deaths occurred in the 50 procedures.
- Controlled hypotension was utilized in 30 operations, showing similar blood loss but shorter procedure durations compared to non-hypotensive cases.
- Sixty percent of patients experienced blood loss less than 20% of estimated blood volume (EBV), while four lost over 50% EBV.
Conclusions:
- Pediatric craniotomy for cerebral AVMs can be performed safely with meticulous anesthetic management.
- Controlled hypotension is a valuable technique for improving surgical conditions in deep-seated AVMs, without increasing blood loss.
- The described anesthetic strategies contribute to successful surgical outcomes in pediatric AVM treatment.
Abstract:
Between 1966 and 1982, 46 patients underwent a total of 50 craniotomies for exploration and excision of cerebral arteriovenous malformations (AVMs) at The Hospital for Sick Children, Toronto. Thirty-three of these patients presented with intracranial haemorrhage, 13 of whom required emergency operations. Thirteen patients underwent elective surgery after investigation of a variety of medical complaints. In most cases, anesthesia was induced with thiopentone followed by a muscle relaxant to facilitate intubation. Anaesthesia was maintained with nitrous oxide and oxygen, a muscle relaxant, halothane and/or an intravenous narcotic, and positive pressure ventilation. In 60 percent of patients, blood loss was less than 20 per cent of estimated blood volume (EBV) although four children lost more than 50 per cent of their EBV. There were no deaths during operation. Controlled hypotension was employed in 30 operations to improve operating conditions during excision of deep-seated AVMs. Blood loss was similar in the non-hypotensive group, but these procedures tended to be of shorter duration. The advantages of various hypotensive techniques in children undergoing operations for cerebral AVMs are discussed and current anaesthetic management at The Hospital for Sick Children is described.
