Ruptures of arteriovenous malformations in children associated with trivial head trauma

Nishi, Tohru; Matsukado, Yasuhiko; Marubayashi, Toru; Masumitsu, Tsutomu; Yamamoto, Haruaki

doi:10.1016/0090-3019(87)90229-1

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…5,8,10,11 The same surgical management has been proposed in adults with profound neurological deterioration resulting from hemorrhagic stroke with mass effect. 1 9 Such high-risk procedures have unpredictable blood loss and potential risks of intractable brain herniation through the dural incision.…”

Section: Discussionmentioning

confidence: 99%

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

Meyer

Orliaguet

Zérah

et al. 2000

Can J Anesth/J Can Anesth

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REPORTS O F INVESTIGATIONCAN J ANESTH 2000 / 47: 8 / pp [758][759][760][761][762][763][764][765][766] Purpose: To assess the impact of emergency management on mortality and morbidity of acute rupture of cerebral arteriovenous malformations resulting in deep coma in children, and the factors predicting outcome. Methods: Retrospective chart review of 20 children with a Glasgow Coma Scale # 8 with acute hemorrhagic stroke from a cerebral arteriovenous malformation rupture was conducted. Protocol included: early resuscitation with tracheal intubation and ventilation after induction of anesthesia with sufentanil, and benzodiazepine, and mannitol 20% or hypertonic saline 7.5% infusion for life-threatening brain herniation. Radiological exploration was limited to contrast-enhanced CT scan preceding immediate surgical decompression. Postoperatively, children were deeply sedated and intracranial pressure monitoring allowed titration with osmotherapy , vasopressors, hyperventilation or barbiturate coma to control cerebral perfusion pressure. Analysis used stratification of the type of hemorrhage (supra or infra tentorial), location (intraparenchymal and subarachnoid, intraparenchymal and intraventricular or intraventricular alone) and relationship between presentation, evolution with resuscitation, type of cerebral lesion, and outcome. Results: Patients had a severe initial presentation (median Glasgow Coma Scale five), eight had unilateral and eight bilateral third nerve palsy. Compressive hematoma in supratentorial localisation represented 75% of the cases. Global mortality was 40%. Persistence of mydriasis after resuscitation increased mortality to 75%. Massive intraventricular flooding was associated with increased mortality. Good functional outcome was achieved in survivors. Conclusion: Acute rupture of an AVM can result in rapidly progressing coma. Emergency management with early resuscitation, minimal radiological exploration before rapid surgical decompression results in a mortality rate of 40%, but a good functional outcome can be expected in the survivors.Objectif : Évaluer l'effet et le pronostic d'une intervention d'urgence sur la mortalité et la morbidité d'une rupture imprévisible de malformations artérioveineuses cérébrales qui ont conduit à un coma profond chez des enfants. Méthode : Un examen rétrospectif des dossiers de 20 enfants, cotés # 8 à l'échelle de Glasgow, qui ont subi un accident hémorragique aigu causé par la rupture de malformations artérioveineuses cérébrales, a été réalisé. Le protocole comportait : une réanimation précoce, une intubation endotrachéale et une ventilation après l'induction de l'anesthésie avec du sufentanil, du mannitol à 20 % ou une perfusion salée hypertonique à 7,5 % pour traiter l'hernie cérébrale grave. L'exploration radiologique s'est limitée à la scanographie de prise de contraste juste avant la décompression chirurgicale. Après l'opération, les enfants ont reçu une forte sédation. Le monitorage de la pression intracrânienne a permis le titrage de l'osmothérapie, des ...

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Section: Discussionmentioning

confidence: 99%

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

Meyer

Orliaguet

Zérah

et al. 2000

Can J Anesth/J Can Anesth

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“…Haemorrhage is by far the commonest initial manifes tation of the lesion (50%-80%) [ [40]. Seizures may be the warning sign of an acute haemorrhage or the result of the epileptogenic effect of parenchymal depo sition following old haemorrhagic events.…”

Section: Clinical Presentationmentioning

confidence: 99%

Cerebral arteriovenous malformations in childhood: state of the art with special reference to treatment

Menovsky

Overbeeke

1997

European Journal of Pediatrics

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Cerebral arteriovenous malformations in children: report on 62 cases

et al. 1994

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A series of 62 children with cerebral arteriovenous malformations admitted to our department in the course of 17 years (1975-1992) was reviewed in a retrospective study. In 54 cases hemorrhagic stroke was the first presenting symptom, followed by epilepsy in five cases. On admission 26 children presented with a neurological deficit, and 21 were admitted with a grade 3 status according to Botterell. Fifty-one malformations were supratentorial (41 hemispheric, 10 deep-seated) while 11 were infratentorial. According to Mori's criteria, 28 lesions were small, 19 medium, and 15 large. Fifty-two children were operated on, with total excision of the malformation achieved in 47 cases. In two children the malformation recurred. The evolution of neurological disorders has been studied with a mean follow-up of 8.5 years. Fifty patients had a satisfactory outcome on the Glasgow Outcome Scale. Four children died. These results were compared with those reported elsewhere in the pediatric literature.

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Ruptures of arteriovenous malformations in children associated with trivial head trauma

Cited by 6 publications

References 14 publications

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

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

Cerebral arteriovenous malformations in childhood: state of the art with special reference to treatment

Cerebral arteriovenous malformations in children: report on 62 cases

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