Neurovascular Pathology, Aneurysmal Subarachnoid Haemorrhage, and AVM Resection — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style neurovascular pathology, aneurysmal subarachnoid haemorrhage, and avm resection viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 48-year-old hypertensive woman presents with a sudden thunderclap headache and collapse. CT brain shows diffuse subarachnoid blood (Fisher Grade 3) and CTA identifies a 7 mm anterior communicating artery aneurysm. She is drowsy but follows commands (Hunt-Hess Grade II). She is scheduled for craniotomy and surgical clipping. Describe your anaesthetic plan to control transmural pressure from induction through dural opening.
• SCENARIO 2: During dissection of the aneurysm neck in a 55-year-old male, the aneurysm ruptures violently before the clip can be applied. Massive arterial bleeding floods the microscope field. Blood pressure is 110/65 mmHg. Outline your immediate, prioritized anaesthetic management to assist the surgeon in controlling the bleeding while preserving brain tissue viability.
• SCENARIO 3: A 30-year-old man undergoes excision of a high-flow 5 cm Spetzler-Martin Grade III parietal AVM. Two hours after successful total resection and uneventful skin closure, during emergence, he develops acute malignant cerebral swelling, systemic hypertension (190/110 mmHg), and a dilated ipsilateral pupil. Detail your diagnostic considerations, immediate management, and postoperative hemodynamic strategy.
• SCENARIO 4: On postoperative day 6 following successful clipping of a ruptured posterior communicating artery aneurysm, a 42-year-old patient develops new-onset expressive dysphasia and right arm weakness. She has been on oral nimodipine. Explain your diagnostic workup and the current medical management of delayed cerebral ischaemia (DCI).