The treatment strategy concerning arteriovenous malformations at pregnant women
https://doi.org/10.17650/1683-3295-2014-0-4-92-96
Abstract
The rupture of intracranial arteriovenous malformation (AVM) during pregnancy is a rare but dangerous event associated with a high perinatal mortality. This review discusses the influence of pregnancy on the AVM rupture as well as presents the main principles of treatment strategy for such pathology and the choice of anesthesia method and types of delivery. The AVM rupture during pregnancy requires immediate surgery in the most cases because of high risk of re-bleeding. The endovascular embolization followed by surgical excision of the AVM is the most effective treatment according to the available data in the literature. Concerning the unruptured AVMs revealed during pregnancy the conservative management of pregnancy is recommended to reduce the risk of intracerebral hemorrhage (arterial blood pressure control, treatment of preeclampsia).
Keywords
артериовенозная мальформация,
субарахноидальное кровоизлияние,
беременность,
роды,
эндоваскулярная эмболизация,
кесарево сечение,
эпидуральная анестезия,
arteriovenous malformation,
subarachnoid hemorrhage,
pregnancy,
delivery,
endovascular embolization,
cesarean section,
epidural anesthesia
About the Authors
A. O. Burshinov
Государственное бюджетное образовательное учреждение высшего профессионального образования «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации
Russian Federation
Russian Federation
A. I. Poroshnichenko
Государственное бюджетное учреждение Рязанской области «Областной клинический перинатальный центр»
Russian Federation
Russian Federation
References
1. Barrow D.L., Reisner A. Natural history of intracranial aneurysms and vascular malformations // Clin Neurosurg. - 1993. - Vol. 40. - P. 3-39.
2. Bevan H., Sharma K., Bradley W. Stroke in young adults // Stroke. - 1990. - Vol. 21(3). - P. 382-86.
3. Coskun D., Mahli A., Yilmaz Z., Cizmeci P. Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report // Cases J. - 2008. - Vol. 1. - P. 327.
4. Couldwell S.M., Kraus K.L., Couldwell W.T. Regression of cerebral arteriovenous malformation in the puerperium // Acta Neurochir (Wien). - 2011. - Vol. 153(2). - P. 359-362.
5. Dias M.S., Sekhar L.N. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium // Neurosurgery. - 1990. - Vol. 27. - P. 855-866.
6. English L.A., Mulvey D.C. Ruptured arteriovenous malformation and subarachnoid hemorrhage during emergent cesarean delivery: a case report // AANA Journal. - 2004. - Vol. 72(6). - P. 423-426.
7. Finnerty J.J., Chisholm C.A., Chapple H. et al. Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance // Am J Obstet Gynecol. - 1999. - Vol. 181(2). - P. 296-303.
8. Forster D.M., Kunkler I.H., Hartland P. Risk of cerebral bleeding from arteriovenous malformations in pregnancy: the Sheffield experience // Stereotact Funct Neurosurg. - 1993. - Vol. 61. - Suppl 1. - P. 20-22.
9. Fujita K., Tsunoda H., Shigemitsu S., Kubo T. Clinical study on intracranial arteriovenous malformation assotiated with pregnancy // Nihon Sanka Fujinka Gakkai Zasshi. - 1995. - Vol. 47(12). - P. 1359-1364.
10. Fukuda K., Hamano E., Nakajima N. et al. Pregnancy and delivery management in patients with cerebral arteriovenous malformation: a single-center experience // Neurol Med Chir (Tokyo). - 2013. Vol. 53(8). - P. 565-570.
11. Gross D.A., Du R. Hemorrhage from arteriovenous malformations during pregnancy // Neurosurgery. - 2012. - Vol. 71(2). - P. 349-355.
12. Hatsukari I., Nagasaka H., Tsuchiya M., Taguchi M. The anesthetic management for elective or emergent cesarean section in patients with intracranial arteriovenous malformation // Masui (Jap J Anesthesiol). - 2000. - Vol. 49(1). - P. 33-36.
13. Horton J.C., Chambers W.A., Lyons S.L. et al. Pregnancy and the risk of hemorrhage from cerebral arteriovenous malformations // Neurosurgery. - 1990. - Vol. 27. - P. 867-872.
14. Jaigobin C., Silver F.L. Stroke and pregnancy // Stroke. - 2000. - Vol. 31. - P. 2948-2951.
15. Jermakowicz W.J., Tomycz L.D., Ghiassi M., Singer R.J. Use of endovascular embolization to treat a ruptured arteriovenous malformation in a pregnant woman: a case report // J Med Case Rep. - 2012. - Vol. 6. - P. 113.
16. Kawasaki N., Uchida T., Yamada M. et al. Conservative management of cerebellar hemorrhage in pregnancy // Int J Gynaecol Obstet. - 1990. - Vol. 31(4). - P. 365-369.
17. Laidler J.A., Jackson I.J., Redfern N. The management of Caesarean section in a patient with an intracranial arteriovenous malformation // Anaesthesia. - 1989. - Vol. 44. - P. 490-491.
18. Lanzino G., Jensen M.E., Cappelletto B., Kassell N.F. Arteriovenous malformations that rupture during pregnancy: a management dilemma // Acta Neurochir (Wien). - 1994. - Vol. 126 (2-4). - P. 102-106.
19. Le L.T., Wendling A. Anesthetic management for cesarean section in a patient with rupture of a cerebellar arteriovenous malformation // J Clin Anesth. - 2009. - Vol. 21. - P. 143-148
20. Nagamine N., Shintani N., Furuya A. et al. Anesthetic managements for emergency cesarean section and craniotomy in patients with intracranial hemorrhage due to ruptured cerebral aneurysm and arteriovenous malformation // Masui. - 2007. - Vol. 56(9). - P. 1081-1084.
21. Perquin D.A., Kloet A., Tans J.T. et al. Intracranial arteriovenous malformations in pregnant women // Ned Tijdschr Geneeskd. - 1999. - Vol. 143. - P. 497-500.
22. Piotin M., Filho C.B., Rothimbakam R. et al. Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy. Case Reports // Am J Obstet Gynecol. - 2001. - Vol. 185. - P. 1261-1262.
23. Robinson J.L., Hall C.S., Sedzimir C.B. Arteriovenous malformations, aneurysms, and pregnancy // J Neurosurg. - 1974. - Vol. 41. - P. 63-70.
24. Sadasivan B., Malik G.M., Lee C., Ausman J.I. Vascular malformations and pregnancy // Surg Neurol. - 1990. - Vol. 33. - P. 305-313.
25. Salvati A., Ferrari C., Chiumarulo L. et al. Endovascular treatment of brain arteriovenous malformations ruptured during pregnancy - a report of two cases // J Neurol Sci. - 2011. - Vol. 308. - P. 158-161.
26. Schwartz J., Lynbrook N.Y. Pregnancy complicated by subarachnoid hemorrhage // Am J Obstet Gynecol. - 1951. - Vol. 62. - P. 539-547.
27. Sinha P.K., Neema P.K., Rathod R.C. Anesthesia and intracranial arteriovenous malformation // Neurology India. - 2004. - Vol. 52(2). - P. 163-170.
28. Trivedi R.A., Kirkpatrick P.J. Arteriovenous malformations of the cerebral circulation that rupture in pregnancy // J Obstet Gynaecol. - 2003. - Vol. 23(5). - P. 484-489.
29. Viscomi C.M., Wilson J., Bernstein I. Anesthetic management of a parturient with an incompletely resected cerebral arteriovenous malformation // Reg Anesth. - 1997. - Vol. 22. - P. 192-197.
30. Wilkins R.H. Natural history of intracranial vascular malformation: A review // Neurosurgery. - 1985. - Vol. 16. - P. 421-430.
31. Yih P.S.W., Cheong K.F. Anaesthesia for Caesarean section in a patient with an intracranial arteriovenous malformation // Anaesth Intensive Care. - 1999. - Vol. 27. - P. 66-68.
Review
For citations:
Burshinov A.O., Poroshnichenko A.I. The treatment strategy concerning arteriovenous malformations at pregnant women. Russian journal of neurosurgery. 2014;(4):92-96. (In Russ.) https://doi.org/10.17650/1683-3295-2014-0-4-92-96
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