The clinical characteristics and treatment of cerebral AVM in pregnancy

Abstract

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.

Recurrent Haemorrhage due to Cerebral Arterio-venous malformation in successive Pregnancies: A rare Presentation

“…According to Liu et al the rate of ICH related to cerebrovascular malformations is similar in pregnant and non-pregnant women and that pregnancy does not increase the rate of first cerebral haemorrhage from an AVM [5] . However, other authors have shown an increased risk of AVM rupture during pregnancy [3] . There is a 2-3% annual risk of ICH with AVMs.…”

“…Amias et al showed a bias in favour of caesarean section in 30 cases when neurological management was conservative [7] . Caesarean section could be a better option as vaginal delivery could precipitate Valsalvamanauver thus precipitate rupture of AVM [2,3,5] . Close collaboration with a team of neurologists, neurosurgeons, obstetricians and anaesthesiologists is mandatory.…”

“…Surgical intervention for ruptured AVM during pregnancy could prevent re-bleed however there is a risk of complications related to the pregnancy, possibility of preterm labour and intrauterine foetal demise. Literature suggests that radiation exposure to the developing foetus secondary to stereotactic radiosurgery and endovascular procedures are below the risk threshold [3] . Nonetheless, these procedures should be performed during pregnancy only when medically necessary.…”

Management of pregnancy complicated with intracranial arteriovenous malformation

“…Our findings indicate that different strategies are needed for pregnancies complicated with intracranial AVM. In the group where the diagnosis had been made at conception, two cases had risk factors for bleeding, such as coexisting aneurysm, smooth venous drainage, venous ectasia or pregnancy induced hypertension (PIH), so these cases were delivered by cesarean section, and vaginal delivery was attempted for other cases using epidural anesthesia. The results provide evidence that this delivery mode is viable in a pregnancy with unruptured cerebral AVM if the above characteristics are absent on MRA/angiography and there is no hypertensive disorder or coagulopathy.…”

Epidural Anesthesia for Cesarean Section in a Patient With Brain Arteriovenous Malformation – A Case Report

“…uzimajući u obzir literaturne podatke i klinički status bolesnice, odlučili smo da se carski rez izvede u epiduralnoj anesteziji jer smo procijenili da je rizik od rupture avM-a niži nego u općoj anesteziji. [1][2][3]15,18 Možemo zaključiti da naš prikaz potvrđuje kako carski rez može biti uspješno izveden kod bolesnice s avM-om v. stupnja.…”