Endovascular Management of Cerebral Arteriovenous Malformations in Pregnancy: Two Case Reports and a Review of the Literature

Abstract

Cerebral arteriovenous malformations are rare, congenital lesions that affect the vasculature of the brain and have the possibility of rupturing. The presentation of a cerebral arteriovenous malformations in a pregnant woman warrants an even greater level of concern due to the maternal physiological changes, which may affect the structural integrity of the arteriovenous malformations and lead to hemorrhaging. A proper plan of action should be deployed to successfully treat pregnant women with cerebral arteriovenous malformations. In all cases, both the mother's and fetus's well being must be taken into consideration. Two cases and the current management options for cerebral arteriovenous malformations in pregnancy are presented. Online databases, such as PubMed provided by the United States National Library of Medicine at the National Institutes of Health, were searched for references to convey endovascular management options for cerebral arteriovenous malformations in pregnancy. Additional references were obtained from articles that were reviewed by the authors. The first case is of a 27-year-old pregnant woman with a right-sided periventricular intraparenchymal hemorrhage. She was treated with an external ventriculostomy drain. The second case is of a 26-year-old pregnant woman with a prior stage 2 embolization of a left parietal arteriovenous malformation. She did not show evidence of intracranial hemorrhage and was treated with further embolization regimens. A multifaceted approach, tailored to the individual patient may be necessary for cerebral arteriovenous malformations in pregnancy. Successful therapeutic strategies often involve close collaboration with a group of obstetricians, neuroradiologists, anesthesiologists, and neurosurgeons.

Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus

“…5 Recent advances in endovascular technology have increased the potential for successful treatment of previously inoperable high-grade AVMs. 2,10,18,32 Extensive endovascular Onyx embolization is feasible in the setting of a ruptured high-grade AVM during pregnancy. 2 Preoperative endovascular embolization can be included when considering surgical excision.…”

“…Sixty-five cases in 35 articles were calculated and analyzed in this study. 1,3–5,10–40 A total of 125 articles (76 non-pertinent, 21 reviews, 11 non-eligible and 23 other than English language) were excluded from a total of 160 articles.…”

Cerebral arteriovenous malformation and pregnancy

“…Данная сосудистая аномалия не является наследственным заболеванием, однако существуют данные о генетической предрасположенности. Кроме того, можно встретить теории о травматическом генезе мальформации [3].…”

“…Кровотечение из АВМ является причиной 5-12% всей материнской смертности, 23% всех внутричерепных кровоизлияний у беременных [3].…”

“…Необходимо решить вопросы о целесообразности ее пролонгирования, выборе времени и метода родоразрешения. По данным современной литературы [3,5,14], авторы отдают предпочтение кесареву сечению (КС), однако описаны случаи самопроизвольных родов, в данной ситуации многое зависит от наличия операций по поводу удаления, либо выключения из кровотока мальформации, выраженности клинических проявлений и перенесенного кровоизлияния в анамнезе. В работе K. Fukuda и соавт.…”