Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(03): 277-279
DOI: 10.1055/s-0041-1735379
Short Communication

Acute Endovascular Management of a Ruptured Choroidal Artery Arteriovenous Malformation in a Peripartum COVID-19-Positive Patient

Gaurav Tyagi 
1   Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
,
Karthik Kulanthaivelu
2   Department of Neuroimaging and Intervention Radiology, NIMHANS, Bengaluru, Karnataka, India
,
Jitender Saini
2   Department of Neuroimaging and Intervention Radiology, NIMHANS, Bengaluru, Karnataka, India
,
Aravind Gowda
2   Department of Neuroimaging and Intervention Radiology, NIMHANS, Bengaluru, Karnataka, India
,
Dwarakanath Srinivas
1   Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has led to significant reduction in specialty care causing delayed presentations and decreased resources for elective procedures. We present here a case of a 29-year-old female, 34 weeks primigravida who presented with a twice ruptured right choroidal artery arteriovenous malformation (AVM). She underwent an immediate external ventricular drain placement followed by an emergency cesarean. She underwent a diagnostic angiogram showing a right choroidal AVM with a feeder artery aneurysm along with small supply to its cortical component by the M4 segment of right middle cerebral artery, draining into the basal vein of Rosenthal and vein of Labbe. The patient underwent embolization of the aneurysm and the choroidal feeders. She improved symptomatically following the procedure with external cerebrospinal fluid diversion for 5 days. At follow-up magnetic resonance imaging, the residual AVM remained stable and is planned for Gamma knife radiosurgery. The newborn was taken care at a neonatal intensive care unit and was started on breastfeed on 16th day of birth once the mother had a negative COVID-19 reverse transcription polymerase chain reaction. In this study, we highlight our experience with the above-mentioned patient profile, the multidisciplinary effort during the pandemic, and the measures taken (isolation ward, COVID-19 dedicated Cath-lab and personal precautions) and advised for tackling COVID-19 patients for endovascular procedures.

Keywords

arteriovenous malformation - AVM in pregnancy - choroidal AVM - COVID-19 - endovascular management of AVM - ruptured AVM


Publication History

Article published online:
05 January 2022

© 2022. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jean WC, Ironside NT, Sack KD, Felbaum DR, Syed HR. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study. Acta Neurochir (Wien 2020; 162 (06) 1229-1240
    CrossrefPubMedGoogle Scholar
  • 2 Deora H, Dange P, Patel K. et al. Management of neurosurgical cases in a tertiary care referral hospital during the COVID-19 pandemic: lessons from a middle-income country. World Neurosurg 2021; 148: e197-e208
    CrossrefPubMedGoogle Scholar
  • 3 Westphal M, Grzyska U. Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations. J Neurosurg 2000; 92 (06) 995-1001
    Google Scholar
  • 4 Porras JL, Yang W, Philadelphia E. et al. Hemorrhage risk of brain arteriovenous malformations during pregnancy and puerperium in a North American cohort. Stroke 2017; 48 (06) 1507-1513
    CrossrefPubMedGoogle Scholar
  • 5 Katsuragi S, Yoshimatsu J, Tanaka H. et al. Management of pregnancy complicated with intracranial arteriovenous malformation. J Obstet Gynaecol Res 2018; 44 (04) 673-680
    CrossrefPubMedGoogle Scholar
  • 6 Davies JM, Lawton MT. Improved outcomes for patients with cerebrovascular malformations at high-volume centers: the impact of surgeon and hospital volume in the United States, 2000-2009. J Neurosurg 2017; 127 (01) 69-80
    CrossrefPubMedGoogle Scholar
  • 7 Fiehler J, Brouwer P, Díaz C. et al. COVID-19 and neurointerventional service worldwide: a survey of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y Terapeutica (SILAN), the Society of Vascular and Interventional Neurology (SVIN), and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN. J Neurointerv Surg 2020; 12 (08) 726-730
    CrossrefPubMedGoogle Scholar
  • 8 Pollock BE, Flickinger JC, Lunsford LD, Bissonette DJ, Kondziolka D. Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations. Neurosurgery 1996; 38 (04) 652-659 , discussion 659−661
    CrossrefPubMedGoogle Scholar
  • 9 Aggour M, White P, Kulcsar Z, Fiehler J, Brouwer P. European Society of Minimally Invasive Neurological Therapy (ESMINT) recommendations for optimal interventional neurovascular management in the COVID-19 era. J Neurointerv Surg 2020; 12 (06) 542-544
    CrossrefPubMedGoogle Scholar