CEREBRAL ARTERIOVENOUS-MALFORMATIONS IN CHILDREN

The treatment of cerebral artenovenous malformations (AVM) or vascular anomalies are challenging neurosurgical procedures for an anaesthetis t. Large AVMs are uncommon in children. Only 18% of AVMs become sympto matic before the age of 15 yr. This series reviews the experience at t his institution during the period of 1982 to 1992. The symptoms at the time of presentation are varied and include haemorrhage (50%), seizur es and hydrocephalus (36%) or congestive cardiac failure (18%). Sympto ms of congestive heart failure predominate in the newborn whilst neuro logical symptoms, such as stroke, seizures or hydrocephalus occur more commonly in infants and older children. Approximately one third of AV Ms in childhood present acutely. Radiological investigations,. e.g., C T scan, MRI and cerebral angiography are essential to identify the pre cise location of the lesion. Therapeutic intervention in the acute pre sentation may involve craniotomy for evacuation of haematoma and treat ment of increased intracranial pressure (ICP). Control of seizures and congestive heart failure may take priority and allow time to plan the elective procedures of embolization and surgical excision of the AVM. Operative intervention is hazardous and peroperative complications ca n be expected in more than 50% of patients. The morbidity and mortalit y associated with cerebral AVM are high, especially in infants who pre sent in the neonatal period with congestive cardiac failure. The overa ll mortality in this series was 20%. Children presenting with intracra nial arteriovenous malformations require a multidisciplinary approach. The successful management of anaesthesia either for embolization or s urgical resection necessitates an understanding of the disciplines of paediatric and neuroanaesthesia. Special care and specific attention t o detail may contribute to reduce the high morbidity and mortality enc ountered in these compromised children.