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Open Access 01-12-2021 | Hypotension | Research article

Controlled arterial hypotension during resection of cerebral arteriovenous malformations

Authors: Katharina Riedel, Marcus Thudium, Azize Boström, Johannes Schramm, Martin Soehle

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

Resection of cerebral arteriovenous malformations (AVM) is technically demanding because of size, eloquent location or diffuse nidus. Controlled arterial hypotension (CAH) could facilitate haemostasis. We performed a study to characterize the duration and degree of CAH and to investigate its association with blood loss and outcome.

Methods

We retrospectively analysed intraoperative arterial blood pressure of 56 patients that underwent AVM-resection performed by the same neurosurgeon between 2003 and 2012. Degree of CAH, AVM size, grading and neurological outcome were studied. Patients were divided into two groups, depending on whether CAH was performed (hypotension group) or not (control group).

Results

The hypotension group consisted of 28 patients, which presented with riskier to treat AVMs and a higher Spetzler-Martin grading. CAH was achieved by application of urapidil, increasing anaesthetic depth or a combination thereof. Systolic and mean arterial blood pressure were lowered to 82 ± 7 and 57 ± 7 mmHg, respectively, for a median duration of 58 min [25% percentile: 26 min.; 75% percentile: 107 min]. In the hypotension group, duration of surgery (4.4 ± 1.3 h) was significantly (p < 0.001) longer, and median blood loss (500 ml) was significantly (p = 0.002) higher than in the control group (3.3 ± 0.9 h and 200 ml, respectively). No case fatalities occurred. CAH was associated with a higher amount of postoperative neurological deficits.

Conclusions

Whether CAH caused neurological deficits or prevented worse outcomes could be clarified by a prospective randomised study, which is regarded as ethically problematic in the context of bleeding. CAH should only be used after strict indication and should be applied as mild and short as possible.

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Title: Controlled arterial hypotension during resection of cerebral arteriovenous malformations
Authors: Katharina Riedel
Marcus Thudium
Azize Boström
Johannes Schramm
Martin Soehle
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Hypotension
Arteriovenous Malformation
Hypotension
Urapidil
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02362-x

2024 ASCO Annual Meeting

Springer Medicine

Controlled arterial hypotension during resection of cerebral arteriovenous malformations

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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