Fukuda Kenji, Hamano Eika, Nakajima Norio, Katsuragi Shinji, Ikeda Tomoaki, Takahashi Jun C, Miyamoto Susumu, Iihara Koji
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Neurol Med Chir (Tokyo). 2013;53(8):565-70. doi: 10.2176/nmc.53.565.
We described pregnancy and delivery management in 9 patients with cerebral arteriovenous malformation (AVM). Six patients presented with intracerebral hemorrhage (ICH) during pregnancy (first hemorrhagic episode); 2 patients presented with headache; and 1 patient with incidental detection of AVM. In the 3 patients with unruptured AVM, the diagnosis was made before pregnancy. In 3 of 6 patients who presented with ICH, AVM removal was performed during pregnancy. One patient required emergency surgery for the mass effect of the hematoma, and 2 patients with Spetzler-Martin grade I and II AVMs underwent elective surgery for the prevention of rebleeding. Radiosurgery for multiple AVMs was performed after delivery in one patient. Surgical resection and radiosurgery were performed after abortion in two patients. Of 3 patients with unruptured AVM, 2 patients became pregnant after radiosurgery and conservative treatment was initiated in 1 patient for Spetzler-Martin grade V AVM. Cesarean section was performed in 5 patients (one with severe uncontrollable pregnancy-induced hypertension) and vaginal delivery in 2 patients (one with grade V AVM). Delivery by obstetrical indication was possible in patients who underwent AVM resection during pregnancy. No rebleeding during pregnancy occurred. The maternal outcome was good except for the 2 patients with consequences of the initial ICH. The fetal outcome was good except for 2 cases of abortion. Pregnancy and delivery management in patients with AVM was successful in our institution. Early surgical intervention for AVM presenting as ICH during pregnancy could prevent rebleeding and improve the maternal and fetal prognosis.
我们描述了9例脑动静脉畸形（AVM）患者的妊娠和分娩管理情况。6例患者在孕期出现脑出血（首次出血事件）；2例患者出现头痛；1例患者的AVM为偶然发现。3例未破裂AVM患者在妊娠前确诊。6例出现脑出血的患者中，3例在孕期进行了AVM切除。1例患者因血肿的占位效应需要急诊手术，2例Spetzler-Martin I级和II级AVM患者为预防再出血接受了择期手术。1例患者在产后接受了针对多发AVM的放射外科治疗。2例患者在流产后进行了手术切除和放射外科治疗。3例未破裂AVM患者中，2例在放射外科治疗后怀孕，1例Spetzler-Martin V级AVM患者开始接受保守治疗。5例患者进行了剖宫产（1例患有严重难以控制的妊娠高血压），2例患者经阴道分娩（1例患有V级AVM）。在孕期接受AVM切除的患者可根据产科指征进行分娩。孕期未发生再出血。除2例因初始脑出血出现并发症的患者外，产妇结局良好。除2例流产病例外，胎儿结局良好。在我们机构，AVM患者的妊娠和分娩管理是成功的。对孕期因脑出血出现AVM的患者进行早期手术干预可预防再出血并改善母婴预后。
