Canadian Journal of Anaesthesia

, Volume 41, Issue 4, pp 321–331 | Cite as

Cerebral arteriovenous malformations in children

  • Carol Millar
  • Bruno Bissonnette
  • R. P. Humphreys
Review Articles


The treatment of cerebral arteriovenous malformations (AVM) or vascular anomalies are challenging neurosurgical procedures for an anaesthetist. Large AVMs are uncommon in children. Only 18% of AVMs become symptomatic before the age of 15 yr. This series reviews the experience at this institution during the period of 1982 to 1992. The symptoms at the time of presentation are varied and include haemorrhage (50%), seizures and hydrocephalus (36%) or congestive cardiac failure (18%). Symptoms of congestive heart failure predominate in the new-born whilst neurological symptoms, such as stroke, seizures or hydrocephalus occur more commonly in infants and older children. Approximately one third of AVMs in childhood present acutely. Radiological investigations, e.g., CT scan, MRI and cerebral angiography are essential to identify the precise location of the lesion. Therapeutic intervention in the acute presentation may involve craniotomy for evacuation of haematoma and treatment 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 can be expected in more than 50% of patients. The morbidity and mortality associated with cerebral AVM are high, especially in infants who present in the neonatal period with congestive cardiac failure. The overall mortality in this series was 20%. Children presenting with intracranial arteriovenous malformations require a multidisciplinary approach. The successful management of anaesthesia either for embolization or surgical resection necessitates an understanding of the disciplines of paediatric and neuroanaesthesia. Special care and specific attention to detail may contribute to reduce the high morbidity and mortality encountered in these compromised children.

Key words

anaesthesia: paediatric, neuroanaesthesia surgery: paediatric, neurological arteriovenous malformation 


Le traitement neurochirurgical des malformations cérébrales artérioveineuses (MAV) représente pour l’anesthésie un défi majeur. Les grosses MAV sont rares chez l’enfant. Seulement 18% deviennent symptomatiques avant l’âge de 15 ans. D’après notre expérience de 1982 à 1992, les premières manifestations sont variables: hémorragie (50%), convulsions et hydrocéphalie Q6%) ou défaillance cardiaque globale (18%). Les symptômes de la défaillance cardiaque globale prédominent chez le nouveau-né alors que les symptômes neurologiques, comme les convulsions et l’hydrocéphalie surviennent plus fréquemment chez le nourrison et l’enfant plus âgé. Environ un tiers des MAV de l’enfance se manifest subitement. Les études radiologiques comme la tomodensitométrie, l’imagerie par résonance magnétique et l’angiographie cérébrale sont essentielles pour l’identification précise du site de la lésion. Le traitement peut signifier une craniotomie pour l’évacuation d’un hématome et le traitement de l’hypertension intracrânienne. Le contrôle des convulsions et de la défaillance cardiaque est souvent prioritaire et permet de planifier des interventions programmées d’embolisation et d’excision chirurgicale de la MAV. L’intervention chirurgicale est dangereuse et on peut s’attendre à des complications peropératoires dans 50% des cas. La morbidité et la mortalité associées aux MAV sont élevées, spécialement en cas de défaillance cardiaque à la période néonatale. Dans notre série, la mortalité totale est de 20%. Ces cas doivent être traités par une équipe multidisciplinaire. Une conduite anesthésique efficace pour embolisation ou résection chirurgicale nécessite une bonne compréhension de l’anesthésie pèdiatrique et neurochirurgicale. Des soins spéciaux et une attention particuliere aux détails peuvent contribuer à diminuer la morbidité et la mortalité élevées de ces enfants très malades.


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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Carol Millar
    • 1
  • Bruno Bissonnette
    • 1
  • R. P. Humphreys
    • 2
  1. 1.Departments of Anaesthesia, The Hospital for Sick ChildrenUniversity of TorontoToronto
  2. 2.Departments of Surgery, The Hospital for Sick ChildrenUniversity of TorontoToronto

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