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Open Access
CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0045-1812883
Brief Report

Arteriovenous Malformations in Pregnancy—Report of Two Patients

Authors

  • Nadun Danushka

    1   Department of Neurosurgery, National Hospital Sri Lanka, Colombo, Sri Lanka

  • M. Ravindri Jayasinghe

    2   Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, United Kingdom

  • Yamini Jeyaratnam

    3   Department of Neurosurgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

  • Deepal K. Attanayake

    1   Department of Neurosurgery, National Hospital Sri Lanka, Colombo, Sri Lanka
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Abstract

Background

Cerebral arteriovenous malformations (AVMs) during pregnancy pose significant risks of hemorrhage, requiring careful multidisciplinary management. The optimal anesthetic and obstetric strategies remain unclear due to limited data.

Methods

We report two cases of pregnant women with cerebral AVMs managed by a multidisciplinary team. Both patients underwent close neurological and fetal monitoring and elective cesarean deliveries under spinal anesthesia combined with norepinephrine infusion to maintain hemodynamic stability.

Results

The first case involved a primigravida with a large, unruptured right parietal AVM presenting with headache and transient visual symptoms. The second was a secundigravida presenting with seizures and subacute hemorrhages. Both deliveries were uneventful, with stable mean arterial pressures maintained intraoperatively, no hypertensive surges, and favorable maternal and neonatal outcomes. Postpartum plans included further neurovascular evaluation.

Conclusion

These cases highlight the importance of individualized, multidisciplinary care in managing cerebral AVMs during pregnancy. Spinal anesthesia with norepinephrine infusion provided stable hemodynamic control and allowed continuous neurological monitoring, potentially reducing rupture risk. Further research is needed to establish standardized protocols.

Keywords

AVM rupture in pregnancy - cerebral arteriovenous malformation - multidisciplinary management


Publication History

Article published online:
12 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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