Use of endovascular embolization to treat a ruptured arteriovenous malformation in a pregnant woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pregnancy has been linked to increased rates of arteriovenous malformation rupture. This link remains a matter of debate and very few studies have addressed the management of arteriovenous malformation in pregnancy. Unruptured arteriovenous malformations in pregnant woman generally warrant conservative management due to the low rupture risk. When pregnant women present with ruptured arteriovenous malformation, however, surgery is often indicated due to the increased risk of re-rupture and associated mortality. Endovascular embolization is widely accepted as an important component of contemporary, multimodal therapy for arteriovenous malformations. Although rarely curative, embolization can facilitate subsequent surgical resection or radiosurgery. No previous reports have been devoted to the endovascular management of an arteriovenous malformation in a pregnant woman.</p> <p>Case presentation</p> <p>A 23-year-old Caucasian woman presented with headache and visual disturbance after the rupture of a left parieto-occipital arteriovenous malformation in the 22nd week of her pregnancy. After involving high-risk obstetric consultants and taking precautions to shield the fetus from ionizing radiation, we proceeded with a single stage of endovascular embolization followed soon after by open surgical resection of the arteriovenous malformation. There were several goals for the angiography in this patient: to better understand the anatomy of the arteriovenous malformation, including the number and orientation of feeding arteries and draining veins; to look for associated pre-nidal or intra-nidal aneurysms; and to partially embolize the arteriovenous malformation via safely-accessible feeders to facilitate surgical resection and minimize blood loss and operative morbidity.</p> <p>Conclusion</p> <p>From our experience and review of the literature, we maintain that ruptured arteriovenous malformations in pregnancy may be managed in a similar manner to those in non-gravid women. Precautions should be taken to reduce the operative time and exposure of the fetus to ionizing radiation and contrast agents.</p

Microneurosurgical Anastomoses for Cerebral Ischemia [Contents]

From jacket: The purpose of this volume is to present a series of important papers on the rapidly growing surgical field of microneurosurgical anastomoses for cerebral ischemia. It includes papers on the indications and results of microneurosurgical bypass anastomoses; on the techniques used to study patients before and after surgery, including cerebral blood flow psychometic testing, etc.; and on the basic mechanisms of cerebral ischemia studies in animals. New ideas are suggested for techniques involving increased use of the occipital arteries and the development of vein, arterial, or prosthetic grafts in place of the STA (superficial temporal artery). Also discussed are the importance of measuring blood flow in the STA where possible, and the measurement of cerebral blood flow pre- and postoperatively to monitor the results. Psychometric studies are shown to be of importance pre- and postoperatively in addition to careful neurologic evaluation