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Cerebral Vascular Malformations in Pregnancy: Considerations for Diagnosis and Management

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Neurological Disorders in Pregnancy

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Abstract

Cerebral vascular malformations comprise a diverse set of pathologies ranging from high-flow arteriovenous malformation and fistula to cavernous malformations and capillary telangiectasia. While rare, vascular malformations occurring during pregnancy present a unique challenge for diagnosis and management due to the need to balance both maternal and fetal well-being. Historically, concern regarding increased risk of rupture and hemorrhage of cerebral vascular malformations has led to the counseling of women with such lesions against pregnancy and vaginal delivery. However, this has been refuted by the results of more recent studies. The presence of a cerebral vascular malformation should not be a contraindication to pregnancy; however, preconception treatment should be performed for high-risk lesions. Identification of a lesion during pregnancy should be treated based on neurosurgical indications. Finally, in women with unruptured, lower risk malformations, vaginal delivery with precautions to minimize undue stress appears to be safe. However, in untreated, higher risk lesions and those that have ruptured, we recommend delivery via cesarean section. Decision making in this setting should follow that of all medical decisions: minimizing risks of harm while maximizing the benefit for the patient.

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Authors and Affiliations

  1. Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Michael S. Rallo

  2. Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Neil Majmundar & Sanjeev Sreenivasan

  3. Neuroradiology, University Radiology, New Brunswick, NJ, USA

    Sudipta Roychowdhury

  4. Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Anil Nanda

  5. Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Gaurav Gupta

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  1. Michael S. Rallo
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  2. Neil Majmundar
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Correspondence to Gaurav Gupta .

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Editors and Affiliations

  1. Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Gaurav Gupta

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Todd Rosen

  3. Department of Neurology, Neurosurgery and Radiology, New York Medical College - Westchester Medical Center, Valhalla, NY, USA

    Fawaz Al-Mufti

  4. Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Anil Nanda

  5. Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Priyank Khandelwal

  6. Department of Neuroradiology, University Radiology, New Brunswick, NJ, USA

    Sudipta Roychowdhury

  7. Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Michael S. Rallo

  8. Department of Cerebrovascular & Endovascular Neurosurgery, Rutgers - Robert Wood Johnson Medical Sc, New Brunswick, NJ, USA

    Sanjeev Sreenivasan

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Rallo, M.S., Majmundar, N., Sreenivasan, S., Roychowdhury, S., Nanda, A., Gupta, G. (2023). Cerebral Vascular Malformations in Pregnancy: Considerations for Diagnosis and Management. In: Gupta, G., et al. Neurological Disorders in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-031-36490-7_9

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