Post-Surgery Complications of Acoustic Neuroma and AV Malformation Removal

Neurofibroma with arteriovenous malformation?

My husband underwent a craniotomy for a left-sided vestibular schwannoma on January 15.
During the surgery, the surgeon discovered an arteriovenous malformation beneath the dura mater, which was also removed.
The surgery lasted approximately six hours, and the nursing staff informed us that he received eight units of blood during the procedure.
He had a slower recovery and spent two days in the intensive care unit.
After being transferred to a regular ward, we noticed symptoms of aphasia and difficulty distinguishing dates and times.
He has since returned home to rest, but we have observed that he sometimes swallows food along with bones, confuses toothpaste with facial cleanser while brushing his teeth, and experiences excessive sleepiness, although he believes he is fine.

I would like to ask the physician what are the potential sequelae of craniotomy for arteriovenous malformation removal? Is his state of confusion normal? Will it improve? How can we assist him? Should rehabilitation for aphasia begin as soon as possible? Will he need regular follow-up with angiography? Thank you, Dr.
Chang, for your patient responses.

ijenh, 30~39 year old female. Ask Date: 2019/01/24

Dr. Zhang Junwei reply Neurosurgery

Because I am unclear about the situation during the surgery, various circumstances can occur during a craniotomy.
The fact that eight bags of blood were transfused indicates a significant amount of blood loss, which may have led to ischemia and hypoxia in some brain tissue, potentially resulting in neurological deficits, though this remains uncertain.
The surgery has concluded, and if we truly want to identify the cause, postoperative computed tomography (CT) and magnetic resonance imaging (MRI) can provide answers.
However, regardless of the situation, the only option is to undergo rehabilitation gradually and wait for natural recovery.

Reply Date: 2019/01/24

More Info

Post-surgery complications following the removal of an acoustic neuroma and associated arteriovenous malformation (AVM) can be quite complex and vary significantly from patient to patient. In your husband's case, the surgery involved significant factors, including the duration of the operation (approximately six hours) and the substantial blood loss (eight units of blood), which can lead to various complications.

Common Post-Surgery Complications
1. Neurological Deficits: Given that the surgery involved the brain, it is not uncommon for patients to experience neurological deficits post-operation. This can include speech difficulties (aphasia), cognitive impairments, and issues with memory or orientation, as you have observed with your husband. These symptoms can arise from direct trauma to brain tissue during surgery or from swelling and inflammation that occurs afterward.

2. Cognitive Changes: The confusion and disorientation regarding time and place can be attributed to postoperative cognitive dysfunction (POCD), which can occur after significant surgeries, especially in older adults. This condition may improve over time, but rehabilitation and support are crucial.

3. Swallowing Difficulties: The fact that your husband is having trouble swallowing food properly may indicate dysphagia, which can occur after brain surgery due to neurological changes affecting the muscles involved in swallowing.

4. Fatigue and Sleepiness: Postoperative fatigue is common and can be exacerbated by medications, anesthesia effects, and the body's healing process. It is essential to monitor this and ensure he is getting adequate rest.

5. Aphasia Rehabilitation: Early intervention in speech therapy is critical for recovery from aphasia. Engaging a speech-language pathologist as soon as possible can help your husband regain his communication skills. The brain has a remarkable ability to adapt, especially if rehabilitation begins early.

Management and Support
- Monitoring and Support: It is essential to provide a supportive environment for your husband. This includes ensuring safety at home, especially with swallowing difficulties and confusion. You may need to modify his diet to include softer foods and ensure he is seated upright while eating.

- Cognitive Rehabilitation: Cognitive exercises and activities can help stimulate his brain and improve orientation and memory. Simple tasks, puzzles, or memory games can be beneficial.

- Regular Follow-ups: Regular follow-up appointments with his healthcare team are crucial. They can monitor his recovery progress and adjust treatment plans as necessary. Imaging studies, such as MRIs or CT scans, may be recommended to assess any changes in the brain post-surgery.

- Blood Vessel Imaging: After AVM removal, regular imaging studies may be necessary to ensure that there are no residual or recurrent vascular malformations. Your healthcare provider will guide you on the frequency of these follow-ups.

Conclusion
In summary, while some of the symptoms your husband is experiencing may be concerning, they are not uncommon following such significant brain surgery. With appropriate rehabilitation, support, and monitoring, many patients can experience significant improvements over time. It is essential to maintain open communication with his healthcare providers to ensure he receives the best possible care and support during his recovery.

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