Fifty consecutive patients (aged 19-77 years, median 56 years) with primary cerebral diseases and the clinical signs of absent cortical and brainstem function were subjected to electroencephalography (EEG), brainstem acoustic evoked potentials (BAEP), extracranial Doppler ultrasonography (ECD) and arterial digital subtraction angiography (DSA). In the majority of cases the results of the technical tests agreed with the clinical signs and were suggestive of brain death. However, in one patient EEG revealed clear bioelectrical activity. In 6 cases, doubts existed about whether the EEG was isoelectric; in 3 of the 6 cases biological activity might have been present. In 31 of 42 patients ECD showed a typical pattern of intracranial circulatory arrest, in 9 of 42 ECD revealed a pattern suggestive of the cessation of cerebral blood flow. In four patients BAEP recordings compatible with brain death were recorded 2-3 days before intracranial circulatory arrest. In 2 patients with isoelectric EEG and absent BAEP arterial DSA demonstrated residual perfusion. The findings are discussed in view of the conceptional differences concerning brain death. It is concluded that the strict application of the concept of death of the whole brain requires angiographic demonstration of absent intracerebral blood flow.

A series of 8 patients with para- and intraventricular arteriovenous malformations (AVM) is presented. Confirmed by histopathological examination or based upon their history all of them sustained recurrent intraventricular or intracerebral haemorrhages. Our results strongly recommend a surgical removal of these AVMs as a feasible and mandatory form of treatment. Conservative methods, e.g., embolisation or gamma beam irradiation leave the patient susceptible to rebleeding which often results in devastating neurological deficits. Total removal of the AVM with minimal surgical trauma was achieved in 7 patients under controlled hypotension and was facilitated by stereotactic guidance in two patients. Post surgical re-bleeding was not observed in any of our patients even though in one case only a subtotal resection of the angiomatous malformation was achieved. Based on our experience, we advocate an inspection of the lateral ventricle in order to avoid leaving any intraventricular portion of the vascular malformation behind. MRI investigation is recommended because the multiplanar images clarify the topographic-anatomic location and its relation to important surgical landmarks.

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