Modulation of blood flow following excision of a high-flow cerebral arteriovenous malformation

Tamaki, Norihiko; Lin, Tingkai; Asada, Masahiro; Fujita, Katsuzo; Tominaga, Shogo; Kimura, Masashi; Ehara, Kazumasa; Matsumoto, Satoshi

doi:10.3171/jns.1990.72.3.0509

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…The cerebral blood flow increases in the ischaemic rim around the AVM [15]. This increase may become exaggerated: the rCBF may rise over the normal values, up to two times the pre-excision values [25,35] and may reach the remote areas, from 2 to 4 cm from the resection site [4]. In most cases, the CO 2 reactivity is restored to normal, and sometimes may show an hyperresponsiveness [5,8].…”

Section: Haemodynamic Modifications Occurring After Resection Of the Avmmentioning

confidence: 99%

“…Some authors have proposed partial temporary clamping of the cervical carotid artery rather than lowering the systemic arterial pressure. This arterial clamping may be performed either intra-operatively [9,28] or postoperatively [35,36] or both, lasting for several days and then gradually tapered off. Several additional measures have been proposed during the post-operative period [15]: intensive care unit during at least 24 hours, reduced fluid intake, administration of diuretics and osmotherapy, and if ICP raises, barbiturate coma.…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

“…Excision of the AVM produces immediate haemodynamic changes in the surrounding brain [4,5,7,12,15,25,26,30,31,35,43] and these changes convert a shunt flow into a perfusion flow [15]. The arterial pressure increases and becomes normal.…”

Section: Haemodynamic Modifications Occurring After Resection Of the Avmmentioning

confidence: 99%

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Complications after multidisciplinary treatment of cerebral arteriovenous malformations

et al. 1996

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According the authors' experience, the emphasis of treatment for cerebral AVMs has now shifted from surgical resection to endovascular embolization. One of the explanations is that endovascular techniques are now employed in the most difficult cases (high grade AVMs). As severe complications of endovascular embolization may also occur for low-grade malformations, the question arises whether surgery or radiosurgery should not be used first for this low-grade group even if embolization is feasible.

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Section: Haemodynamic Modifications Occurring After Resection Of the Avmmentioning

confidence: 99%

Section: Therapeutic Implicationsmentioning

confidence: 99%

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Complications after multidisciplinary treatment of cerebral arteriovenous malformations

et al. 1996

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“…In this case, it is also beneficial to know how the blood flow was changed by the treatment. 2 For the acquisition of a cerebrovascular angiographic sequence, iodine-based contrast agent is injected into one of the carotid or vertebral arteries and a sequence of x-ray images is acquired. Besides information about the endovascular lumen, the angiographic sequence contains information about the haemodynamics, as it is possible to see how the contrast agent is transported by the blood.…”

Section: Introductionmentioning

confidence: 99%

Model-based blood flow quantification from DSA: quantitative evaluation on patient data and comparison with TCCD

et al. 2012

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Purpose: To support intra-interventional decisions on diagnosis and treatment of cerebrovascular diseases, a method providing quantitative information about the blood flow in the vascular system is proposed.Method: This method combines rotational angiography to extract the 3D vessel geometry and digital subtraction angiography (DSA) to obtain the flow observations. A physical model of blood flow and contrast agent transport is used to predict the propagation of the contrast agent through the vascular system. In an iterative approach, the model parameters, including the volumetric blood flow rate, are adapted until the prediction matches the observations from the DSA. The flow estimation method was applied to patient data: For 24 patients, the volumetric blood flow rate was determined from angiographic images and for 17 patients, results were compared with transcranial color coded Doppler (TCCD) measurements.Results: The agreement of the x-ray based flow estimates with TCCD was reasonable (bias Δ M = 3%, correlation ρ = 0.76) and reproducibility was clearly better than the reproducibility of the acquired TCCD measurements.Conclusion: Overall we conclude that it is feasible to model the contrast agent transport in patients and to utilize the flow model to quantify their blood flow with angiographic means.

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“…This phenomenon is referred to as nor mal perfusion pressure breakthrough (NPPB) (Spet zler and Wilson, 1978). Although continuous monitoring of the hemodynamics during therapeutic procedures for A VM or during the course of NPPB is indispensable for satisfactory management of A VM, it is not always easy in clinical settings (Batjer et al, 1989;Rosenblum et al, 1987;Tamaki et al, 1990;Young et al, 1988).…”

mentioning

confidence: 99%

Hemodynamic Simulation Study of Cerebral Arteriovenous Malformations. Part 2. Effects of Impaired Autoregulation and Induced Hypotension

Nagasawa

Kawanishi

Kondoh

et al. 1996

J Cereb Blood Flow Metab

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Summary:The hemodynamic changes occurring during obliteration procedures for arteriovenous malformations (AVM) have not been fully elucidated, Therefore, we un dertook a simulation study using a compartmental flow model to investigate the role of altered autoregulatory conditions in the development of hyperperfusion during obliteration of large high-flow A VM. Induced hypoten sion was also simulated to evaluate its usefulness in re ducing the incidence and severity of the event. As the A VM flow was decreased during the obliteration proce dures, feeder pressure increased and drainer pressure de creased, with a concomitant increase in the perfusion pressure in the brain tissue surrounding the A VM. Cere bral blood flow (CBF) remained constant at 50 miiOO g-l min -1 in the presence of autoregulation and increased to Microsurgery and intravascular surgery have re cently contributed considerably to progress in the management of formerly inoperable large arteriove nous malformations (A VM) of the brain (Andrews and Wilson, 1987;Drake, 1979;Stein and Solomon, 1990;Vinuela et al., 1991). Reduction of AVM flow volume induced by these therapeutic modalities is known to increase feeder pressure and decrease drainer pressure, both of which elevate the pressure gradient across the nidus as well as the perfusion pressure in the surrounding brain.Under physiological conditions, an autoregula tory mechanism maintains constant cerebral blood Received December 2, 1994; final revision received May 15, 1995; accepted May 15, 1995. Address correspondence and reprint requests to Dr. Shiro Nagasawa at Department of Neurosurgery, Osaka Medical Col lege, Daigaku-cho 2-7, Takatsuki-City, Osaka 569, Japan.Abbreviations used: A VM, arteriovenous malformation; CBF, cerebral blood flow; LAR, lower limit of autoregulatory range; NPPB, normal perfusion pressure breakthrough. 16267 ml 100 g -1 min -1 in its absence. When the lower limit of the autoregulatory pressure range (LAR) was shifted from 60 to 50 or 40 mm Hg, the flow volume increased markedly from 67 to 77 ml 100 g -1 min -I or to 92 ml 100 g -1 min -I after complete obliteration. Decrease in LAR would be a cause of the hyperperfusion. Induced sys temic hypotension was found to be effective in reducing the magnitude of these hemodynamic changes, when in duction was appropriately performed in a stepwise fash ion. A simulation study is useful in clarifying the various hemodynamic changes that develop during the treatment of A VM. Key Words: Arteriovenous malformation Autoregulation-Cerebral hemodynamics-Compart mental flow model-Regional cerebral blood flow Simulation.flow (CBF). However, the brain tissue surrounding a large high-flow A VM is considered to be chroni cally exposed to hypoperfusion, which may result in the impairment of autoregulatory mechanisms. These increased hemodynamic loads are likely to result in an abnormal increase in CBF, with cere bral edema and hemorrhage, in some large high flow AVM. This phenomenon is referred to as nor mal perfusion pressure breakthroug...

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Modulation of blood flow following excision of a high-flow cerebral arteriovenous malformation

Cited by 11 publications

References 16 publications

Complications after multidisciplinary treatment of cerebral arteriovenous malformations

Complications after multidisciplinary treatment of cerebral arteriovenous malformations

Model-based blood flow quantification from DSA: quantitative evaluation on patient data and comparison with TCCD

Hemodynamic Simulation Study of Cerebral Arteriovenous Malformations. Part 2. Effects of Impaired Autoregulation and Induced Hypotension

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