Document Detail


Pressure autoregulation is intact after arteriovenous malformation resection.
MedLine Citation:
PMID:  8474637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The loss of autoregulatory control of cerebral perfusion to changes in perfusion pressure in tissue remote from an arteriovenous malformation (AVM) has been proposed as the mechanism underlying "normal perfusion pressure breakthrough." This study is the first direct test of this mechanism. Studies were performed during the resection of moderate to large AVMs in 25 patients undergoing 28 procedures under isoflurane anesthesia. Cerebral blood flow (CBF) was measured (xenon-133 method) in the hemisphere adjacent to the nidus before resection after dural exposure (pre), after AVM removal before dural closure at spontaneous systemic blood pressure (post), and, finally, with the mean arterial pressure increased by 20 mm Hg, using phenylephrine (post-BP). AVM resection resulted in a significant enhancement of perfusion in the adjacent hemisphere (30 +/- 2 vs. 25 +/- 1 ml/100g/min, P < 0.01), but no further increase of CBF occurred during increased perfusion pressure (30 +/- 2 ml/100g/min). One patient suffered a postoperative hemorrhage and another developed intraoperative brain swelling during the course of the resection that necessitated staging the procedure. These two patients had the highest increases in CBF, but intact pressure autoregulation. Preserved autoregulation to increased mean arterial pressure after resection does not support a hemodynamic mechanism for the observed increase in CBF from before the resection to after the resection. Pathological events, however, do appear to be related to increases in hemispheric perfusion.
Authors:
W L Young; A Kader; I Prohovnik; E Ornstein; L H Fleischer; N Ostapkovich; L D Jackson; B M Stein
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Neurosurgery     Volume:  32     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1993 Apr 
Date Detail:
Created Date:  1993-05-18     Completed Date:  1993-05-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  491-6; discussion 496-7     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Blood Pressure*
Cerebrovascular Circulation
Female
Homeostasis*
Humans
Intracranial Arteriovenous Malformations / physiopathology,  surgery*
Male
Middle Aged
Postoperative Complications
Postoperative Period
Grant Support
ID/Acronym/Agency:
R01-NS27713/NS/NINDS NIH HHS
Comments/Corrections
Comment In:
Neurosurgery. 1993 Oct;33(4):772-4   [PMID:  8232824 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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