Emergency management of deeply comatose children with acute rupture of cerebral arteriovenous malformations

Meyer, Philippe; Orliaguet, Gilles; Zérah, Michel; Charron, Brigitte; Jarreau, Marie‐Madeleine; Brunelle, Françis; Laurent-Vannier, A.; Carli, Pierre

doi:10.1007/bf03019478

Cited by 41 publications

(37 citation statements)

References 32 publications

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“…Kuhmonen et al [7] reported 49 patients with ruptured bAVMs, aged between 2 months and 78 years, and showed that clinical outcome correlated significantly with the Hunt and Hess grade, intraventricular hemorrhage and age; however, it appeared that patients with poor conscious levels were distributed among groups of good and poor outcomes; thus a single parameter such as conscious level is not informative enough in daily clinical practice. Similar results appeared in another two reports [2,9]. We also encountered a similar problem when a single parameter or a single existing scoring scale was evaluated (table 3; fig.…”

Section: Discussionsupporting

confidence: 68%

“…In the literature, clinical outcome of patients with ruptured bAVMs with respect to patients’ admission condition has been discussed in several reports [5,6,7,9], but information about prognostic parameters applicable to daily clinical practice is still lacking. Kuhmonen et al [7] reported 49 patients with ruptured bAVMs, aged between 2 months and 78 years, and showed that clinical outcome correlated significantly with the Hunt and Hess grade, intraventricular hemorrhage and age; however, it appeared that patients with poor conscious levels were distributed among groups of good and poor outcomes; thus a single parameter such as conscious level is not informative enough in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…When children with ruptured bAVMs are first admitted to hospital, they are usually in their worst clinical condition. It is important to understand how clinical outcome is related to clinical and imaging parameters on admission in these children; however, even taking into account both adult and pediatric patients with ruptured bAVMs, there are only a few published reports focusing on the study of this relationship [5,6,7,8,9]. These reports have generated some evidence to support a long-held belief that clinical outcome of these patients seems to correlate with the severity of hemorrhage, but apart from characterizing the severity of hemorrhage by the conscious level [5,7] and adverse predictive value of third nerve palsy [6], they were insufficient to provide more detailed information such as the degree of impairment of consciousness which may have an adverse predictive value and the significance of other clinical or imaging parameters on admission.…”

Section: Introductionmentioning

confidence: 99%

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Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Wong

Fong

2010

Pediatr Neurosurg

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Aims: To gain a better understanding of how clinical outcome in children with ruptured brain arteriovenous malformations (bAVMs) correlates with clinical and imaging parameters on admission. Methods: The authors retrospectively reviewed patients with bAVMs, aged 18 or below, managed at their hospital between January 1992 and December 2008. Clinical outcome was assessed using the modified Rankin Scale (mRS). Patients with ruptured bAVMs were analyzed; their clinical parameters and computerized tomography findings on admission were recorded. Clinical outcome was then evaluated against admission scores using the Glasgow Coma Scale (GCS), the World Federation of Neurosurgical Societies Grading System of Subarachnoid Hemorrhage (WFNS-SAH), the Spetzler-Martin grade, the intracerebral hemorrhage score and 2 other independent parameters, namely pupillary response and significant focal neurological injuries. Spearman’s correlation coefficient, linear regression analysis and multivariate logistic regression analysis were used for data analysis. Results: 40 pediatric patients with bAVMs were found and 32 of them presented with hemorrhage (80%). In the 32 children with ruptured bAVMS, follow-up ranged between 7 and 204 months (median 100.5 months). The complete excision/obliteration rate as confirmed by digital subtraction angiography was 73.3%. The mRS scores at the last follow-up were: grades 0–II in 87.5%; grades IV–V in 6.25%, and grade VI in 6.25%. The Spetzler-Martin grade, the intracerebral hemorrhage score, the WFNS-SAH grade, the GCS scores, and a combined scoring scale consisting of the GCS, pupillary response and significant focal neurological injuries correlated significantly with clinical outcome 6 months after hemorrhage. However, on the scatter diagrams, it appeared that only the combined scoring scale might be valid for clinical practice. Multivariate logistic regression analysis showed that the combined scoring scale was a statistically significant independent predictor of clinical outcome 6 months after hemorrhage. Conclusion: In this series of pediatric patients with ruptured bAVMs, although various grading scales correlated significantly with clinical outcome 6 months after hemorrhage, only the combined scoring scale might have the potential to be applied to predict clinical outcome in these children.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Wong

Fong

2010

Pediatr Neurosurg

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“…34 Furthermore, it has been studied widely in the same experimental contexts as starches 24 and has been in clinical use for many decades. 35,36 Normal saline, one of the most commonly used solutions, was not chosen as a control because its volume effect is not comparable with that of colloids, given that it is easily lost from the intravascular space and, therefore, does not act effectively as a volume expander. The distribution among the three compartments (intravascular, extracellular, and intracellular) depends highly on the concentration of sodium.…”

Section: Discussionmentioning

confidence: 99%

L’hydroxyéthylamidon 130/0,4 atténue les dommages hépatiques précoces causés par les lésions d’ischémie/reperfusion

Catré

Viana

Cabrita

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Ischemia/reperfusion injury (IRI) remains a clinical challenge. We tested the hypothesis that fluid therapy using hydroxyethyl starch (HES) 130/0.4 during the early phase of IRI in rat liver decreases markers of hepatic injury. Methods We induced liver IRI in three groups of rats anesthetized with ketamine and chlorpromazine by means of 60 min of segmental hepatic ischemia followed by 120 min of reperfusion. At the onset of reperfusion, Group 1 (IRI ? HES; n = 12) was given 13 mLÁkg -1 of HES; Group 2 (IRI ? HS; n = 12) received the same volume of 7.5% saline (HS), and Group 3 (IRI-only; n = 12) received no fluid. Three other groups of 12 animals each were shamoperated and received the same fluid as the test groups. We euthanized the animals after three hours, drew blood for alanine aminotransferase (ALT) quantification, and took ischemic liver samples for histomorphological study.Results Serum ALT activity was greater in all of the IRI groups than in the sham-operated animals. The ALT activity was 1,081 ± 575 IUÁL -1 in IRI ? HES Group 1; 2,363 ± 1,839 IUÁL -1 in IRI ? HS Group 2; and 2,866 ± 2,491 IUÁL -1 in IRI-only Group 3. There was a statistically significant difference between the IRI ? HES and the IRIonly groups (P = 0.001), but not between the IRI ? HS and the IRI-only groups (P [ 0.05). Likewise, histological scores were greater in all IRI groups compared with the sham-operated animals. Scores were higher in the IRI-only group (median 3.5) than in the groups receiving fluid (IRI ? HES median 2; IRI ? HS median 3). The difference between IRI ? HES and IRI-only was statistically significant (P = 0.008) but not so between IRI ? HS and IRI-only (P [ 0.05). Conclusions Giving HES 130/0.4 attenuates rat liver IRI compared with no fluid, while giving HS does not. This suggests a role for HES in hepatoprotection associated with liver IRI. RésuméObjectif La le´sion d'ische´mie/reperfusion (IR) reste un de´fi clinique. Nous avons e´mis l'hypothe`se qu'une the´rapie liquidienne a`base d'hydroxye´thylamidon (HES) 130/0,4 administre´e pendant la phase pre´coce d'IR dans un mode`le he´patique de rat, diminuerait les marqueurs de la le´sion he´patique. Méthode Nous avons provoque´une le´sion d'IR au niveau du foie dans trois groupes de rats anesthe´sie´s à la ke´tamine et a`la chlorpromazine en cre´ant une ische´mie he´patique segmentaire de 60 min suivie de 120 min de reperfusion. Au de´but de la reperfusion, le groupe 1 (IR ? HES; n = 12) a reçu 13 mLÁkg -1 de HES; le groupe 2 (IR ? HS; n = 12) a reçu le meˆme volume de se´rum physiologique 7,5 % (HS), et le groupe 3 (IR seule;This investigation was supported, in part, by research funds of the School of Medicine of the University of Coimbra (GAPI 08/08).

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“…Urgent surgery was undertaken given the patient's rapidly declining level of consciousness, and because of extensive intraoperative blood loss, a clip was placed on a middle cerebral artery (MCA) AVM feeder to gain hemorrhage control. Decompressive craniectomy and prolonged intracranial pressure monitoring with sedation were performed 15 following intracerebral clot evacuation, but AVM resection was not attempted by the attending neurosurgeon. After a prolonged intensive care unit stay, she made a good recovery and had only mild contralateral hemiparesis (Table 2) prior to definitive AVM surgery 12 weeks later.…”

Section: History and Examinationmentioning

confidence: 99%

Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Walkden¹,

Zádor²,

Herwadkar³

et al. 2015

PED

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OBJECT Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population. METHODS The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients. RESULTS All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively. CONCLUSIONS Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.

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Emergency management of deeply comatose children with acute rupture of cerebral arteriovenous malformations

Cited by 41 publications

References 32 publications

Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

L’hydroxyéthylamidon 130/0,4 atténue les dommages hépatiques précoces causés par les lésions d’ischémie/reperfusion

Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

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