Postoperative Hyperperfusion Associated With Steal Phenomenon Caused by a Small Arteriovenous Malformation-Case Report-

Abstract

A 41-year-old woman presented with a small occipital arteriovenous malformation (AVM) manifesting as headache. Cerebral angiography showed an AVM in the right occipital lobe fed by the right temporooccipital artery and draining into the superior sagittal sinus and right transverse sinus. Single photon emission computed tomography showed the steal phenomenon in the ipsilateral temporal cortex fed by the main feeding artery preoperatively, and hyperperfusion in the same cortex after removal of the AVM. Postoperative systolic blood pressure was maintained between 100 and 120 mmHg to avoid disastrous hemorrhagic complications. Cerebral blood flow evaluation before and after surgery is important to avoid postoperative disastrous complications even in patients with small AVM.

Measurement of Blood Flow in Arteriovenous Malformations before and after Embolization Using Arterial Spin Labeling

“…The "success" of such an intervention is usually expressed as percentage of nidus reduction as judged by conventional angiography taking into consideration the change in extension of the nidus as well as the change in flow. More than 20 years ago, the measurement of cerebral blood flow (CBF) in patients with AVMs by means of single photon emission tomography (SPECT) was mainly performed to investigate perinidal perfusion deficits and the pressure-break-through phenomenon [1][2][3][4][5][6] . The same applies to studies using positron emission tomography (PET) 7,8 or xenon-enhanced computed tomography 9,10 .…”

Normal Perfusion Pressure Breakthrough Following AVM Resection: A Case Report and Review of the Literature

“…In addition, it provides a direct temporal relationship that illustrates the cause and effect association between hyperperfusion and induced systemic hypotension with resolution of neurological symptoms. This case adds to the growing literature that concludes strict blood pressure control can be useful in the setting of complete AVM obliteration [7,13,32].…”

Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour

“…Cerebral hyperaemia is reported after many medical procedures and situations, such as carotid endarterectomy, removal of intracranial arteriovenous malformation (AVM), or in the recovery period of cardiac arrest and traumatic brain injury . Severe cerebral hyperperfusion, called cerebral hyperperfusion syndrome, can cause unilateral headaches, face and eye pain, seizures, deterioration of consciousness levels, and focal neurological deficits .…”

“…If cerebral vascular autoregulation partially remains, CBF changes will be less severe than MAP changes in the autoregulation range. Therefore, many investigators share the concept that strict control of blood pressure in the post‐operative period may be effective in preventing cerebral hyperperfusion …”

“…Post‐operative cerebral hyperperfusion increases the risk of disastrous complications, such as intracranial hypertension, cerebral oedema, and intracerebral haemorrhage . A majority of researchers suggest that strict control of blood pressure should be effective in preventing post‐operative cerebral hyperperfusion injuries . The presumption is that blood pressure and CBF have a positive correlation.…”