Hemodynamic aspects of cerebral arteriovenous malformations

Helge Nornes M.D.1 and Arne Grip M.Sc.1
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  • 1 Department of Neurosurgery, National Hospital of Norway, Rikshospitalet, Oslo, Norway
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✓ Local hemodynamics were studied in 16 patients undergoing total extirpation of cerebral arteriovenous malformation (AVM). Directional Doppler technique was used for the registration of blood velocities in vessels feeding and draining the AVM. Calculated flow in single feeding arteries ranged from 3 to 550 ml/min (average, 180 ml/min). An estimation of total AVM flow was possible in nine patients, and ranged from 150 to more than 900 ml/min (average, 490 ml/min). Pressure recordings were made from feeding arteries at their entrance to the AVM. This pressure was well below the systemic arterial blood pressure in all cases, and ranged from 40 to 77 mm Hg (average, 56 mm Hg). On temporary occlusion, this stump pressure instantly rose to from 55 to 95 mm Hg (average, 76 mm Hg). Draining vein pressure before occlusion ranged from 8 to 23 mm Hg (average, 15 mm Hg), and fell to zero in all patients when the AVM was occluded. These data and other clinical observations are discussed with regard to adjacent brain-tissue perfusion, and with special emphasis on the circulatory breakthrough that can follow the occlusion of these high-capacity shunts.

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  • 1.

    Amacher AL, , Allcock JM, & Drake CG: Cerebral angiomas; the sequelae of surgical treatment. J Neurosurg 37:571575, 1972 Amacher AL, Allcock JM, Drake CG: Cerebral angiomas; the sequelae of surgical treatment. J Neurosurg 37:571–575, 1972

    • Search Google Scholar
    • Export Citation
  • 2.

    Drake CG: Personal communication, 1977 Drake CG: Personal communication, 1977

  • 3.

    Ekstrøm-Jodal B, , Häggendal E, & Linder L-E, >et al: Cerebral blood flow autoregulation at high arterial pressures and different levels of carbon dioxide tension in dogs. Eur Neurol 6:610, 1971 Ekstrøm-Jodal B, Häggendal E, Linder L-E, et al: Cerebral blood flow autoregulation at high arterial pressures and different levels of carbon dioxide tension in dogs. Eur Neurol 6:6–10, 1971

    • Search Google Scholar
    • Export Citation
  • 4.

    Feindel W, & Perot P: Red cerebral veins. A report on arteriovenous shunts in tumors and cerebral scars. J Neurosurg 22:315325, 1965 Feindel W, Perot P: Red cerebral veins. A report on arteriovenous shunts in tumors and cerebral scars. J Neurosurg 22:315–325, 1965

    • Search Google Scholar
    • Export Citation
  • 5.

    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
  • 6.

    Folkow B, , Gurèvich M, & Hallbäck Y, >et al: The hemodynamic consequences of regional hypotension in spontaneously hypertensive and normotensive rats. Acta Physiol Scand 83:532541, 1971 Folkow B, Gurèvich M, Hallbäck Y, et al: The hemodynamic consequences of regional hypotension in spontaneously hypertensive and normotensive rats. Acta Physiol Scand 83:532–541, 1971

    • Search Google Scholar
    • Export Citation
  • 7.

    Folkow B, & Sivertsson R: Adaptive changes in “reactivity” and wall/lumen ratio in cat blood vessels exposed to prolonged transmural pressure difference. Life Sci 7 ( Part I): 12831289, 1968 Folkow B, Sivertsson R: Adaptive changes in “reactivity” and wall/lumen ratio in cat blood vessels exposed to prolonged transmural pressure difference. Life Sci 7 (Part I):1283–1289, 1968

    • Search Google Scholar
    • Export Citation
  • 8.

    Forster DMC, , Steiner L, & Håkanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562570, 1972 Forster DMC, Steiner L, Håkanson S: Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37:562–570, 1972

    • Search Google Scholar
    • Export Citation
  • 9.

    French LA, & Chou SN: Conventional methods of treating intracranial arteriovenous malformations. Prog Neurol Surg 3:274319, 1969 French LA, Chou SN: Conventional methods of treating intracranial arteriovenous malformations. Prog Neurol Surg 3:274–319, 1969

    • Search Google Scholar
    • Export Citation
  • 10.

    Green HD, & Rapela CE: Blood flow in passive vascular beds. Circ Res 15 (Suppl): 1116, 1964 Green HD, Rapela CE: Blood flow in passive vascular beds. Circ Res 15 (Suppl):11–16, 1964

    • Search Google Scholar
    • Export Citation
  • 11.

    Harper AM: Autoregulation of cerebral blood flow: influence of the arterial blood pressure on the flow through the cerebral cortex. J Neurol Neurosurg Psychiatry 29:398403, 1966 Harper AM: Autoregulation of cerebral blood flow: influence of the arterial blood pressure on the flow through the cerebral cortex. J Neurol Neurosurg Psychiatry 29:398–403, 1966

    • Search Google Scholar
    • Export Citation
  • 12.

    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
  • 13.

    Kunc Z: Surgery of arteriovenous malformations in the speech and motor-sensory regions. J Neurosurg 40:293303, 1974 Kunc Z: Surgery of arteriovenous malformations in the speech and motor-sensory regions. J Neurosurg 40:293–303, 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    Lassen NA: Autoregulation of cerebral blood flow. Circ Res 15 (Suppl): 201204, 1964 Lassen NA: Autoregulation of cerebral blood flow. Circ Res 15 (Suppl):201–204, 1964

    • Search Google Scholar
    • Export Citation
  • 15.

    McDonald DA: Blood Flow in Arteries. London: Edward Arnold, 1974 McDonald DA: Blood Flow in Arteries. London: Edward Arnold, 1974

  • 16.

    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
  • 17.

    Murphy JP: Cerebrovascular Disease. Chicago: Year Book Medical, 1954 Murphy JP: Cerebrovascular Disease. Chicago: Year Book Medical, 1954

    • Search Google Scholar
    • Export Citation
  • 18.

    Nornes H: Electromagnetic blood flowmetry in small vessel surgery. An experimental study. Scand J Thorac Cardiovasc Surg 10:144148, 1976 Nornes H: Electromagnetic blood flowmetry in small vessel surgery. An experimental study. Scand J Thorac Cardiovasc Surg 10:144–148, 1976

    • Search Google Scholar
    • Export Citation
  • 19.

    Nornes H: Hemodynamic aspects in the management of carotid-cavernous fistula. J Neurosurg 37:687694, 1972 Nornes H: Hemodynamic aspects in the management of carotid-cavernous fistula. J Neurosurg 37:687–694, 1972

    • Search Google Scholar
    • Export Citation
  • 20.

    Nornes H: Pulsatile blood flow pattern in cerebral circulation, in Langfitt TW, , McHenry LC Jr, & Reivich M, >et al (eds): Cerebral Circulation and Metabolism. New York/Heidelberg/Berlin: Springer-Verlag, 1975, pp 152154 Nornes H: Pulsatile blood flow pattern in cerebral circulation, in Langfitt TW, McHenry LC Jr, Reivich M, et al (eds): Cerebral Circulation and Metabolism. New York/Heidelberg/Berlin: Springer-Verlag, 1975, pp 152–154

    • Search Google Scholar
    • Export Citation
  • 21.

    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
  • 22.

    Nornes H, , Knutzen HB, & Wikeby P: Cerebral arterial blood flow and aneurysm surgery. Parts 1 and 2. J Neurosurg 47:810827, 1977 Nornes H, Knutzen HB, Wikeby P: Cerebral arterial blood flow and aneurysm surgery. Parts 1 and 2. J Neurosurg 47:810–827, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    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
  • 24.

    Nornes H, & Magnaes B: Safety and accuracy in the clinical recording of cerebrospinal fluid pressure. Acta Neurochir 29:4151, 1973 Nornes H, Magnaes B: Safety and accuracy in the clinical recording of cerebrospinal fluid pressure. Acta Neurochir 29:41–51, 1973

    • Search Google Scholar
    • Export Citation
  • 25.

    Pool JL: Treatment of arteriovenous malformations of the cerebral hemisphere. J Neurosurg 19:139141, 1962 Pool JL: Treatment of arteriovenous malformations of the cerebral hemisphere. J Neurosurg 19:139–141, 1962

    • Search Google Scholar
    • Export Citation
  • 26.

    Pool JL, & Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain: Diagnosis and Treatment. New York: Harper and Row, 1965 Pool JL, Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain: Diagnosis and Treatment. New York: Harper and Row, 1965

    • Search Google Scholar
    • Export Citation
  • 27.

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

    • Search Google Scholar
    • Export Citation
  • 28.

    Strandgaard S, , Olesen J, & Skinhøj E, >et al: Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1:507510, 1973 Strandgaard S, Olesen J, Skinhøj E, et al: Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1:507–510, 1973

    • Search Google Scholar
    • Export Citation
  • 29.

    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
  • 30.

    Yaşargil MG, , Jain KK, & Antic J, >et al: Arteriovenous malformations of the splenium of the corpus callosum: microsurgical treatment. Surg Neurol 5:514, 1976 Yaşargil MG, Jain KK, Antic J, et al: Arteriovenous malformations of the splenium of the corpus callosum: microsurgical treatment. Surg Neurol 5:5–14, 1976

    • Search Google Scholar
    • Export Citation

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