Endovascular treatment of brain arteriovenous malformations ruptured during pregnancy — A report of two cases

Salvati, Andrea; Ferrari, Cristina; Chiumarulo, Luigi; Medicamento, N.; Dicuonzo, Franca; Blasi, Roberto De

doi:10.1016/j.jns.2011.06.015

Cited by 11 publications

(9 citation statements)

References 16 publications

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“…Therefore, the principle for goal of management of a ruptured brain AVM is to minimize the risk of re-bleeding until delivery. However, it is difficult to make the optimal decisions for the treatment of coma-producing brain AVMs, as there are no definitive guidelines [ 7 , 8 ].…”

Section: Case Presentationmentioning

confidence: 99%

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience

et al. 2016

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BackgroundAlthough brain arteriovenous malformations (AVM) usually remain asymptomatic during pregnancy, they can cause intracranial hemorrhage and lead to serious neurological deficits. Nowadays, it is accepted that treatment of a ruptured brain AVM during pregnancy should be based on neurologic, not obstetric, indications.Recently, endovascular treatment has been recognized as a treatment option associated in pregnant patients with brain AVMs.Case presentationA 34-year-old woman presented at 25 weeks of gestation with a history of severe headache followed by severe consciousness disturbance. Brain CT showed a subcortical hematoma in the right occipital lobe along with bilateral intraventricular hematomas. A cerebral angiogram was performed to confirm the diagnosis, which revealed right occipital AVM. At 27 weeks of gestation, endovascular embolization of the AVM was attempted under general anesthesia. The feeding artery and the nidus were simultaneously obliterated by injection of 50 % n-butyl-cyanoacrylate. As a result, the blood flow into the nidus was drastically decreased and the risk of re-bleeding was substantially reduced. At 38 weeks of gestation, elective cesarean section was performed to deliver the baby under combined spinal-epidural anesthesia (CSEA). An infant weighing 3665 g was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively.Postoperative analgesia was provided by a continuous infusion of ropivacaine via the epidural catheter. The infant was confirmed as not having any congenital anomalies.On POD 5, both of the patient and the infant were discharged home without any medical problems. The mother has shown no evidence of re-bleeding from the intracranial lesion since, and the infant is thriving well.ConclusionsEndovascular treatment in pregnant women is associated with various unique concerns. However, it can be carried out safely and effectively and is useful not only for saving the mother’s life but also for allowing the pregnancy to continue to term.

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Section: Case Presentationmentioning

confidence: 99%

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience

et al. 2016

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“…Salvati et al reported two cases of ruptured AVM in pregnancy. 28 One case was a 23-year-old woman, 19 weeks pregnant, in whom cerebral angiography showed an intraventricular AVM supplied by a callosomarginal artery and drained by a single deep vein with drainage vein ectasia. This AVM was treated by N-butyl cyanoacrylate (NBCA) embolization under general anesthesia.…”

Section: Endovascular Embolization For Cerebral Avm In Pregnancymentioning

confidence: 99%

The clinical characteristics and treatment of cerebral AVM in pregnancy

Liu

2015

Neuroradiol J

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Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few, and they provide different results, pregnancy will increase the hemorrhagic risk of AVM and ruptured cerebral AVM in pregnancy should be actively treated. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. Results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy was below the safety value and was safe. For an unruptured AVM in pregnancy, if there are no bleeding factors, e.g. no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, then it should be observed conservatively.

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“…Salvati et al reported two cases of ruptured AVM in pregnancy. 28 One case was a 23-year-old woman, 19 weeks pregnant, in which cerebral angiography showed an intraventricular AVM supplied by a callosomarginal artery and drained by a single deep vein with drainage vein ectasia. This AVM was treated by n-butyl cyanoacrylate (NBCA) embolization under general anesthesia.…”

Section: Endovascular Embolization For Cerebral Avm In Pregnancymentioning

confidence: 99%

The clinical characteristics and treatment of cerebral AVM in pregnancy

2015

Neuroradiol J

View full text Add to dashboard Cite

Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few and there are different results between them, pregnancy will increase the hemorrhagic risk of AVM, and ruptured cerebral AVM in pregnancy should be treated actively. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. The results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy is below the safety value and is safe. Unruptured AVM in pregnancy, if there is no bleeding factor, such as no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, should be observed conservatively.

show abstract

Endovascular treatment of brain arteriovenous malformations ruptured during pregnancy — A report of two cases

Cited by 11 publications

References 16 publications

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience

The clinical characteristics and treatment of cerebral AVM in pregnancy

The clinical characteristics and treatment of cerebral AVM in pregnancy

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