Abstract
The treatment of large high flow AVM's is one of the most difficult operations not only because of the operative technique but also due to the postoperative NPPB. Pre and postoperative cerebral blood circulatory changes in 10 cases of large high flow AVM were evaluated by SPECT study, angiography and CT studies. Preoperative SPECT showed a misery perfusion area (decreased CBF, increased CBV) around the nidus in 4 cases.In these cases a postoperative 1st day dynamic scan showed remarkable hyperperfusion areas around the former nidus. But these hyperperfusion areas normalized 7 days after the operation.Nidal volume of these 4 cases was over 70 cu cm. Local CBF during operation increased suddenly after application of temporary clips on the main feeders. An angiogram taken one or two weeks after the operation showed remarkable stagnating artery, fragile vessels and prolonged circulation time.In conclusion, these cases were expected to develop postoperative NPPB. Pre and postoperative SPECT study, especially a postoperative dynamic SPECT study done after the 1st day, was the most useful examination for ascertaining the postoperative NPPB.
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