Normal perfusion pressure breakthrough syndrome in giant arteriovenous malformations

Kato, Yōkō; Sano, Hirotoshi; Nonomura, K.; Kanno, Tetsuo; Katada, Kazuhiro; Takeshita, G; Toyama, Hiroshi

doi:10.1080/01616412.1997.11740783

Cited by 12 publications

(3 citation statements)

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“…Two possible causes for the hyperperfusion were proposed: (1) the microcirculation in the AVM area could not protect itself from the rapid increase of pressure from low to normal through automatic regulation reaction, resulting in the breakthrough of normal perfusion pressure (NPPB). This hypothesis is supported by the fact that there are significant differences between perinidal capillaries and other capillaries in the brain, which helps to prove that perinidal capillaries may be apt to rupture once bAVM is removed (5,32). ( 2)Occlusive hyperemia, the outcome of propagated thromboembolism in a dilated venous drainage system that became superfluous after AVM excision is occlusive hyperemia (35).…”

Section: Discussionmentioning

confidence: 92%

“…Preoperative partial embolization of the malformation can assist in surgical positioning and decrease blood flow of the malformation, which contributes to minimizing the risk of intraoperative bleeding (28)(29)(30)(31). However, after bAVM resection, excessive perfusion of adjacent cortical tissue and pathological increase of local intravascular pressure (32)(33)(34), may generate cerebral hemorrhage or edema, which worsens the postoperative course. Two possible causes for the hyperperfusion were proposed: (1) the microcirculation in the AVM area could not protect itself from the rapid increase of pressure from low to normal through automatic regulation reaction, resulting in the breakthrough of normal perfusion pressure (NPPB).…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Monitoring Cerebral Blood Flow During the Treatment of Brain Arteriovenous Malformations in Hybrid Operating Room by Laser Speckle Contrast Imaging

et al. 2022

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BackgroundHemodynamic changes caused by hybrid surgery for brain arteriovenous malformations (bAVM) are usually related to long-term lesions from “blood stealing”. There are currently no viable low-cost, noninvasive procedures for assessing cerebral perfusion in the operating room. This study aims to investigate the use of intraoperative laser speckle contrast image (LSCI) software in AVM surgery.MethodsIn Zhongnan Hospital of Wuhan University, 14 patients who underwent surgery with LSCI were collected. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM embolization and resection, we assessed the transit time between feeding arteries and drainage veins by intraoperative digital subtraction angiography (DSA). Meanwhile, LSCI was performed at pre-embolization, post-embolization, and after complete resection of bAVM.ResultsIn this study, the transit time of bAVM before and after embolization was compared, the transit time before embolization was significantly shorter than that after embolization (p < 0.05). We also got good visualization of relative CBF, in addition, to flow imaging in the cortical vasculature round bAVM with LSCI. The flux of post-surgery was significantly higher than pre-embolization (p < 0.01).ConclusionHemodynamic variable assessment plays an important role in the resection of AVM in the hybrid operative room and LSCI can be used to visualize and evaluate cortical cerebral blood flow to detect pathological hyperperfusion in real-time with a good spatial-temporal resolution in a sensitive and continuous, non-invasive mode.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring Cerebral Blood Flow During the Treatment of Brain Arteriovenous Malformations in Hybrid Operating Room by Laser Speckle Contrast Imaging

et al. 2022

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“…When the AVM is removed more normal perfusion pressure is restored and there is a high incidence of postoperative haematomas arising in the parenchyma surrounding the AVM bed. This is one of the features of what has been termed the normal perfusion pressure breakthrough phenomenon [19,20].…”

Section: Surgerymentioning

confidence: 95%