Evaluation of cerebral AVM's using transcranial Doppler ultrasound

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  • 1 Department of Neurosurgery, Rikshospitalet, The National Hospital, University of Oslo, Oslo, Norway, and Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
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✓Blood flow velocities in basal cerebral arteries were recorded noninvasively in 28 patients with cerebral arteriovenous malformations (AVM's) and were correlated with the angiographic findings. In normal arteries remote from the AVM, flow velocities ranged from 44 to 94 cm/sec (median 65 cm/sec) with pulsatility indexes from 0.65 to 1.10 (median 0.87). This is consistent with findings in normal individuals. Arteries feeding the AVM's were identified by the high flow velocities (ranging from 75 to 237 cm/sec, median 124 cm/sec). The pulsatility index ranged from 0.22 to 0.74 (median 0.48). The difference of these results from findings in normal remote arteries was highly significant (p < 0.001). Hyperventilation tests illustrated the hemodynamic difference between an AVM and normal cerebrovascular beds.

Flow velocity measurements permitted noninvasive diagnosis of AVM's in 26 of the 28 patients. Furthermore, the identification of individual feeding arteries permitted good definition of the anatomical localization of individual AVM's. Flow velocity measurements combined with computerized tomography scans are useful in the diagnosis of AVM's. With the feeding artery's configuration identified on angiography, flow velocity measurements permit a new insight into the “hemodynamic dimension” of an AVM and its possible effects on adjacent normal brain-tissue perfusion in the individual patient.

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Contributor Notes

Address reprint requests to: Karl-Fredrik Lindegaard, M.D., Department of Neurosurgery, Rikshospitalet, Pilestredet 32, N-0027 Oslo 1, Norway.
  • 1.

    Aaslid R, , Huber P, & Nornes H: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60:3741, 1984 Aaslid R, Huber P, Nornes H: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60:37–41, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Aaslid R, , Markwalder TM, & Nornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769774, 1982 Aaslid R, Markwalder TM, Nornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774, 1982

    • Search Google Scholar
    • Export Citation
  • 3.

    Aoki N, & Mizutani H: Arteriovenous malformation in the territory of the occluded middle cerebral artery with massive intraoperative brain swelling: case report. Neurosurgery 16:660662, 1985 Aoki N, Mizutani H: Arteriovenous malformation in the territory of the occluded middle cerebral artery with massive intraoperative brain swelling: case report. Neurosurgery 16:660–662, 1985

    • Search Google Scholar
    • Export Citation
  • 4.

    Bakay L, & Sweet WH: Cervical and intracranial intra-arterial pressures with and without vascular occlusion. Surg Gynecol Obstet 95:6775, 1952 Bakay L, Sweet WH: Cervical and intracranial intra-arterial pressures with and without vascular occlusion. Surg Gynecol Obstet 95:67–75, 1952

    • Search Google Scholar
    • Export Citation
  • 5.

    Burki NK, & Albert RK: Noninvasive monitoring of arterial blood gases. A report of the ACCP Section on Respiratory Pathophysiology. Chest 83:666670, 1983 Burki NK, Albert RK: Noninvasive monitoring of arterial blood gases. A report of the ACCP Section on Respiratory Pathophysiology. Chest 83:666–670, 1983

    • Search Google Scholar
    • Export Citation
  • 6.

    Feindel W, , Yamamoto YL, & Hodge CP: Red cerebral veins and the cerebral steal syndrome. Evidence from fluorescein angiography and microregional blood flow by radioisotopes during excision of an angioma. J Neurosurg 35:167179, 1971 Feindel W, Yamamoto YL, Hodge CP: Red cerebral veins and the cerebral steal syndrome. Evidence from fluorescein angiography and microregional blood flow by radioisotopes during excision of an angioma. J Neurosurg 35:167–179, 1971

    • Search Google Scholar
    • Export Citation
  • 7.

    Gosling RG, & King DH: Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med 67:447449, 1974 Gosling RG, King DH: Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med 67:447–449, 1974

    • Search Google Scholar
    • Export Citation
  • 8.

    Hauge A, , Thoresen M, & Walløe L: Changes in cerebral blood flow during hyperventilation and CO2-breathing measured transcutaneously in humans by a bidirectional, pulsed, ultrasound Doppler blood velocitymeter. Acta Physiol Scand 110:167173, 1980 Hauge A, Thoresen M, Walløe L: Changes in cerebral blood flow during hyperventilation and CO2-breathing measured transcutaneously in humans by a bidirectional, pulsed, ultrasound Doppler blood velocitymeter. Acta Physiol Scand 110:167–173, 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Huber P, & Handa J: Effect of contrast material, hypercapnia, hyperventilation, hypertonic glucose and papaverine on the diameter of the cerebral arteries. Angiographic determination in man. Invest Radiol 2:1732, 1967 Huber P, Handa J: Effect of contrast material, hypercapnia, hyperventilation, hypertonic glucose and papaverine on the diameter of the cerebral arteries. Angiographic determination in man. Invest Radiol 2:17–32, 1967

    • Search Google Scholar
    • Export Citation
  • 10.

    Kaplan HA, , Aronson SM, & Browder EJ: Vascular malformations of the brain. An anatomical study. J Neurosurg 18:630635, 1961 Kaplan HA, Aronson SM, Browder EJ: Vascular malformations of the brain. An anatomical study. J Neurosurg 18:630–635, 1961

    • Search Google Scholar
    • Export Citation
  • 11.

    Lindegaard KF, , Bakke SJ, & Grolimund P, et al: Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound. J Neurosurg 63:890898, 1985 Lindegaard KF, Bakke SJ, Grolimund P, et al: Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound. J Neurosurg 63:890–898, 1985

    • Search Google Scholar
    • Export Citation
  • 12.

    Lindegaard KF, , Grip A, & Nornes H: Precerebral haemodynamics in brain tamponade. Part 1: Clinical studies on blood flow velocity. Neurochirurgia (Stuttg) 23:133142, 1980 Lindegaard KF, Grip A, Nornes H: Precerebral haemodynamics in brain tamponade. Part 1: Clinical studies on blood flow velocity. Neurochirurgia (Stuttg) 23:133–142, 1980

    • Search Google Scholar
    • Export Citation
  • 13.

    Lindegaard KF, , Grip A, & Nornes H: Precerebral haemodynamics in brain tamponade. Part 2: Experimental studies. Neurochirurgia (Stuttg) 23:187196, 1980 Lindegaard KF, Grip A, Nornes H: Precerebral haemodynamics in brain tamponade. Part 2: Experimental studies. Neurochirurgia (Stuttg) 23:187–196, 1980

    • Search Google Scholar
    • Export Citation
  • 14.

    Markwalder TM, , Grolimund P, & Seiler RW, et al: Dependency of blood flow velocity in the middle cerebral artery on end-tidal carbon dioxide partial pressure. A transcranial Doppler study. J Cereb Blood Flow Metab 4:368372, 1984 Markwalder TM, Grolimund P, Seiler RW, et al: Dependency of blood flow velocity in the middle cerebral artery on end-tidal carbon dioxide partial pressure. A transcranial Doppler study. J Cereb Blood Flow Metab 4:368–372, 1984

    • Search Google Scholar
    • Export Citation
  • 15.

    Mullan S, , Brown FD, & Patronas NJ: Hyperemic and ischemic problems of surgical treatment of arteriovenous malformations. J Neurosurg 51:757764, 1979 Mullan S, Brown FD, Patronas NJ: Hyperemic and ischemic problems of surgical treatment of arteriovenous malformations. J Neurosurg 51:757–764, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Murphy JP: Cerebrovascular Disease. Chicago: Year Book Medical, 1954, pp 248249 Murphy JP: Cerebrovascular Disease. Chicago: Year Book Medical, 1954, pp 248–249

    • Search Google Scholar
    • Export Citation
  • 17.

    Nornes H, & Grip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:456464, 1980 Nornes H, Grip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:456–464, 1980

    • Search Google Scholar
    • Export Citation
  • 18.

    Nornes H: , Grip A, & Wikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 1: Arteriovenous malformations. J Neurosurg 50:145151, 1979 Nornes H, Grip A, Wikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 1: Arteriovenous malformations. J Neurosurg 50:145–151, 1979

    • Search Google Scholar
    • Export Citation
  • 19.

    Nornes H, , Lundar T, & Wikeby P: Cerebral arteriovenous malformations; results of microsurgical management. Acta Neurochir 50:243257, 1979 Nornes H, Lundar T, Wikeby P: Cerebral arteriovenous malformations; results of microsurgical management. Acta Neurochir 50:243–257, 1979

    • Search Google Scholar
    • Export Citation
  • 20.

    Olesen J, , Paulson OB, & Lassen NA: Regional cerebral blood flow in man determined by the initial slope of the clearance of intra-arterially injected 133Xe. Theory of the method, normal values, error of measurement, correction for remaining radioactivity, relation to other flow parameters and response to PaCO2 changes. Stroke 2:519540, 1971 Olesen J, Paulson OB, Lassen NA: Regional cerebral blood flow in man determined by the initial slope of the clearance of intra-arterially injected 133Xe. Theory of the method, normal values, error of measurement, correction for remaining radioactivity, relation to other flow parameters and response to PaCO2 changes. Stroke 2:519–540, 1971

    • Search Google Scholar
    • Export Citation
  • 21.

    Olivecrona H, & Riives J: Arteriovenous aneurysms of the brain. Their diagnosis and treatment. Arch Neurol Psychiatry 59:567602, 1948 Olivecrona H, Riives J: Arteriovenous aneurysms of the brain. Their diagnosis and treatment. Arch Neurol Psychiatry 59:567–602, 1948

    • Search Google Scholar
    • Export Citation
  • 22.

    Parkinson D, & Bachers G: Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. J Neurosurg 53:285299, 1980 Parkinson D, Bachers G: Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. J Neurosurg 53:285–299, 1980

    • Search Google Scholar
    • Export Citation
  • 23.

    Solomon RA, & Michelsen WJ: Defective cerebrovascular autoregulation in regions proximal to arteriovenous malformations of the brain: a case report and topic review. Neurosurgery 14:7882, 1984 Solomon RA, Michelsen WJ: Defective cerebrovascular autoregulation in regions proximal to arteriovenous malformations of the brain: a case report and topic review. Neurosurgery 14:78–82, 1984

    • Search Google Scholar
    • Export Citation
  • 24.

    Spetzler RF, , Wilson CB, & Weinstein P, et al: Normal perfusion pressure breakthrough theory. Clin Neurosurg 25:651672, 1978 Spetzler RF, Wilson CB, Weinstein P, et al: Normal perfusion pressure breakthrough theory. Clin Neurosurg 25:651–672, 1978

    • Search Google Scholar
    • Export Citation
  • 25.

    Voldby B, , Enevoldsen EM, & Jensen FT: Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 62:5967, 1985 Voldby B, Enevoldsen EM, Jensen FT: Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 62:59–67, 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Wilson CB, , U HS, & Domingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:446454, 1979 Wilson CB, U HS, Domingue J: Microsurgical treatment of intracranial vascular malformations. J Neurosurg 51:446–454, 1979

    • Search Google Scholar
    • Export Citation

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