The treatment of cerebral arteriovenous malformations (AVM) or vascular anomalies are challenging neurosurgical procedures for an anaesthetist. Large AVMs are uncommon in children. Only 18% of AVMs become symptomatic before the age of 15 yr. This series reviews the experience at this institution during the period of 1982 to 1992. The symptoms at the time of presentation are varied and include haemorrhage (50%), seizures and hydrocephalus (36%) or congestive cardiac failure (18%). Symptoms of congestive heart failure predominate in the newborn whilst neurological symptoms, such as stroke, seizures or hydrocephalus occur more commonly in infants and older children. Approximately one third of AVMs in childhood present acutely. Radiological investigations., e.g., CT scan, MRI and cerebral angiography are essential to identify the precise location of the lesion. Therapeutic intervention in the acute presentation may involve eraniotomy for evacuation of haematoma and treatment of increased intracranial pressure (ICP). Control of seizures and congestive heart failure may take priority and allow time to plan the elective procedures of embolization and surgical excision of the AVM. Operative intervention is hazardous and peroperative complications can be expected in more than 50% of patients. The morbidity and mortality associated with cer-ebral AVM are high, especially in infants who present in the neonatal period with congestive cardiac failure. The overall mortality in this series was 20%. Ctu'ldren presenting with intra-cranial arteriovenous malformations require a multidisciplinary approach. The successful management of anaesthesia either for embolization or surgical resection necessitates an understanding of the disciplines of paediatric and neuroanaesthesia. Special care and specific attention to detail may contribute to reduce the high morbidity and mortality encountered in these compromised chiMren. Le traitement neurochirurgical des malformations c~r(brales ar-t~riaveineuses (MAV) repr$sente pour l'anesth$sie un d~fi ma-jeur. Les grosses MAV sont rares chez l'enfant. Seulement 18% deviennent symptomatiques at,ant l'~ge de 15 ans. D'aprbs notre experience de 1982 h 1992, les premieres manifestations sont variables: h~morragie (50%), convulsions et hydroc~phalie (36%) ou d$faillance cardiaque globale (18%). Les sympt&mes de la d~faillance cardiaque globale pr~dominent chez le nouveau-r~ alors que les sympt6mes neurologiques, comme les convulsions et I'hydroc#phalie surviennent plus fr#quemment chez le nourrison et l'enfant plus ~g~. Environ un tiers des MAV de l'enfanee se manifest subitement. Les ~tudes radio-logiques comme la tomodensitom~trie, lfmagerie par r~so-nance magndtique et l'angiogeaphie c~r~brale sont essentielles pour l'identification precise du site de la ldsion. Le traitement peut signifier une cmniotomie pour I'g'vacuation d'un h~ma-tome et le traitement de l~ypertension intracr~nienne. Le contr6le des convulsions et de la d~faillance cardiaque est sou-vent prioritaire et permet de planifier des ...

We report the case of a 27-year-old man who underwent surgical excision of an intracranial extra-axial right temporal lesion. A preoperative embolization with the use of a mixture of N-butyl-cyanoacrylate, ultrafluid-lipiodol, and micronized tungsten was necessary to devascularize the tumor. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact and tumor-free 18 months after surgery. To our knowledge, this is the fifth patient reported with intracranial epithelioid hemangioendothelioma and the first adult patient for whom complete data are available.

Aggressive intensive care approach to heart failure and pulmonary hypertension leading to early neurointervention results in good survival rates with low morbidity even in cases of high-risk neonatal VGAM. Combined hemodynamic treatment can improve outcome in neonates with cardiac failure secondary to VGAM, although there is the risk of precipitating systemic hypoperfusion and renal failure. A moderate prematurity may not prevent both interventional approach and good outcome.

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Previous studies displayed a significant prevalence of BVR type C variants in ISAH. Conversely in our study we recognized variant B as prevalent, in which the BVR bifurcates to drain anteriorly into the uncal vein and posteriorly into the Galenic system. Similarly to variant C (in which the BVR drains via perimesencephalic "bridging" veins into cavernous, sphenoparietal, petrosal sinus or directly into transverse sinus) also variant B might be subjected to those stress mechanisms and intrinsic system 'fragility' and for reasons yet to determine, sets off a consequent hemorrhage with clinical and radiological features typical of ISAH.