Presence and removal of arteriovenous malformation: Impact of regional cerebral blood flow, as assessed with xenon/CT.
In 26 patients with supratentorial AVMs and 1 patient with a dural arteriovenous fistula, the regional cerebral blood flow (rCBF) was assessed by means of xenon-enhanced computed tomography (Xe/CT) before and after complete resective surgery. Each assessment comprised an acetazolamide challenge in order to check the cerebrovascular reserve capacity. While scanning through the AVM was purposely avoided, a single brain slice at the level of the basal ganglia was examined. Five regions of interest (ROIs) in gray matter of the AVM-bearing hemisphere were compared to the contralateral ROIs and categorized into 7 CBF groups. Interhemispherical differences exceeding 20% of the contralateral value in either direction were considered to the significant. AVM-related (AVM-R) and AVM-non-related (AVM-NR) ROIs were looked at separately. Before surgery, all possible rCBF patterns were found, including a normal rCBF as well as a reduced or an increased rCBF, either in AVM-R, AVM-NR, or both. After AVM removal, a rCBF increase in AVM-R is relatively rare, whereas a rCBF decrease is twice as frequent. A rCBF drop to a level of impaired reserve capacity correlates with the occurrence of post-operative neurological deficit.
Van Roost
D
D
Neurochirurgische Universitätsklinik Bonn, Germany.
Schramm
J
J
Solymosi
L
L
Hartmann
A
A
D000086:Acetazolamide; D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000503:physiopathology* / Q000601:surgery; D003287:Contrast Media; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014978:Xenon
D003287:Contrast Media; D014978:Xenon; D000086:Acetazolamide