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Anaesthetic management of arteriovenous malformations of the vein of galen

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Abstract

Arteriovenous malformations of the vein of Galen, though rare, are associated with a significant mortality. The anaesthetic management of patients with this defect during surgery may be complicated by massive blood loss and congestive heart failure. Four patients under 18 months of age underwent craniotomies for arteriovenous malformations of the vein of Galen. Since two required a second craniotomy for ligation of residual feeding vessels, there were six procedures in the four patients. Average blood loss per procedure was estimated at 126 per cent of blood volume. One patient died during operation and one had an intra-operative cardiac arrest. Both of these patients had associated cardiac failure. In the presence of a compromised myocardium, sudden blood loss or attempts at induced hypotension may result in inadequate diastolic perfusion of the heart and precipitate cardiac arrest. Consequently, these patients should be maintained in a euvolaemic state with transfusion and attempts at controlled hypotension should be avoided.

Résumé

Les malformations artério-veineuses de l’ampoule de Galien, bien que rares, sont associées avec un taux de mortalité important. La conduite anesthésique nécessitée par la chirurgie de cette condition peut se compliquer d’hémorragie massive et d’insuffisance cardiaque congestive. Quatre jeunes patients de moins de 18 mois on subi des craniotomies pour des malformations artério-veineuses de l’ampoule de Galien. Comme deux de ces patients ont dû subir une deuxième craniotomie pour ligature de vaisseaux nourriciers superficiels on a compté six interventions sur quatre patients. La perte sanguine moyenne par intervention a été évaluée à 126 pour cent du volume sanguin. Un patient est mort pendant l’intervention et un autre a subi un arrêt cardiaque per-opératoire. Deux de ces patients souffraient également d’insuffisance cardiaque. En présence de myocarde défaillant, l’hémorragie subite ou des tentatives d’hypotension contrôlée peuvent causer une perfusion dyastolique inadéquate du coeur et précipiter un arrêt cardiaque. En conséquence ces malades devraient être maintenus dans un état euvolémique avec des transfusions et on devrait éviter toute tentative d’induire l’hypotension contrôlée.

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Correspondence to M. E. McLeod or R. E. Creighton or R. P. Humphreys.

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McLeod, M.E., Creighton, R.E. & Humphreys, R.P. Anaesthetic management of arteriovenous malformations of the vein of galen. Can. Anaesth. Soc. J. 29, 307 (1982). https://doi.org/10.1007/BF03007517

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Key Words

  • Surgery
  • Cerebral Arteriovenous Malformation
  • vein of Galen
  • Anaesthetic Management