Intractable brain swelling during cerebral AV malformation s
Severe brain swelling during routine neurosurgery can herald serious consequences. Failure to control brain swelling despite adequate measures warns of a surgical cause and should be dealt efficiently.

Published in the Indian Journal of Anesthesiology, the authors report a case of an adult female who developed an intraoperative acute subdural haematoma (SDH) and consequent intractable brain swelling during surgery of supratentorial arteriovenous malformation (AVM). Such a manifestation of contralateral acute SDH during supratentorial AVM surgery has not been reported earlier.

Key takeaways:-
- Haemorrhage occurring at areas remote from the site of intracranial surgery comprises an uncommon entity.

- The pathophysiology is incomprehensive, despite several theories trying to explain it. Awareness among the neurosurgeons and anaesthesiologists is important for early recognition of this rare but potentially dreadful complication.

- Unexpected intraoperative brain swelling should always be dealt meticulously.

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