Normal perfusion pressure breakthrough syndrome in giant arteriovenous malformations

Abstract

The treatment of largel high-flow cerebral arteriovenous malformations is one of the most difficult operations which neurosurgeons encounter because of the complex surgery and the post-operative effects on the brain. We have evaluated 10 patients with largel high-flow AVMs who underwent surgical resection. Patients were investigated with contrast-enhanced computed tomography and magnetic resonance imagingl 1231-IMP single photon emission computed tomography (SPECT) studies of cerebral flow and cerebral vasodilatory functionl intraoperative Laser Doppler flowmetry (4 or 10 patients)1 and conventional angiography. The volume of the arteriovenous malformation nidi ranged from 32.8 to 210.5 cc. SPECT imaging performed on the first post-operative day showed marked hyperperfusion in the brain tissue surrounding the resected nidusl and these regions were normal on images on the 7th post-operative day. Laser Doppler flo wmetry showed suddenl and marked increase in CBF immediately following placement of temporary clips on the main feeding artery. Angiograms done on 7-14 days following surgery showed a stagnating arterYI fragile vessell and a prolonged circulation time. Our results indicate that pre- and post-operative SPECT studYI especially a dynamic SPECT study done on the first post-operative daYI was the most useful examination for ascertaining the post-operative normal perfusion pressure breakthrough. [Neural Res 1997; 19: 117–123]