Craniotomy for intracranial vascular malformations

Craniotomy for intracranial vascular malformations

Anesthesia type	General
Airway	ETT
Lines and access	Large bore IV x2 Arterial line ± Central line (if arterial nidus)
Monitors	Standard 5-lead ECG Core temp UOP ABG ± CVP (if arterial nidus) Neuromonitoring
Primary anesthetic considerations
Preoperative	Characterize neurologic deficits
Intraoperative	Smooth induction Hemodynamic goals vary Hypotension ↑ risk of steal If arterial nidus: Hypertension ↑ risk of rupture Have adenosine available Decrease CRMO2
Postoperative	Avoid hypertension after excision (risk of hyperemia)
Article quality
Editor rating	Comprehensive
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A craniotomy for intracranial vascular malformations is a neurosurgical procedure performed to remove vascular malformations which are considered high risk for rupture or produce neurologic symptoms.

Overview

Background

• Intracranial vascular malformations are congenital defects
• Typically present in young adulthood (most commonly 15-40 years old)
• Wide anatomic variability
  • High-flow arteriovenous malformations (AVM)
  • Low-flow angiographically occult vascular malformations (AOVM)
    • Cavernous malformations
    • "Cryptic" AVMs
    • Capillary telangiectasias
    • Transitional malformations
  • Low-flow venous angiomas

Indications

• The Spetzler-Martin AVM grading system estimates morbidity and mortality of surgery

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications