Neuraxial Anesthesia in Parturients With Intracranial Arteriovenous Malformations: A Case Report

A cerebral arteriovenous malformation (AVM) is an abnormal nidus of blood vessels that directly connects the arteries and veins in the brain, bypassing the normal capillary network. Due to the rarity of this condition, specific anesthetic management guidelines for patients with intracranial AVMs are limited. In patients with cerebral AVMs, increased intracranial pressure is a concern in the setting of recent hemorrhage, significant mass effect, or venous congestion. In these types of cases, anesthetic management becomes more complex. The risk of AVM rupture during pregnancy, though rare, is a potentially fatal complication and may be considered a relative contraindication to neuraxial anesthesia. We present two cases of pregnant patients with prior diagnosis of AVM who successfully underwent cesarean section using neuraxial anesthesia without any intraoperative or postoperative complications. Neuraxial anesthesia was selected over general anesthesia to minimize hemodynamic fluctuations, reduce intracranial pressure risk, and allow continuous neurological monitoring. These cases add to the limited body of evidence suggesting that neuraxial anesthesia can be a viable option for such patients, provided that comprehensive multidisciplinary care is implemented throughout the preoperative, intraoperative, and postoperative periods.