Perioperative monitoring of cerebral hemodynamics in patients with arteriovenous malfomations

V.B. Semenyutin, V.A. Aliev, V.P. Bersnev, A. Patzak*, P.I. Nikitin, V.A. Pak, A.V. Kozlov

Russian Polenov Neurosurgical Institute, St. Petersburg, Russia
* Johannes-Mueller Institute of Physiology University Hospital Charite, Humboldt- University of Berlin, Germany

 

Perioperative monitoring of cerebral hemodynamics allows to specify indications for neurosurgical interventions and to correct treatment tactics.

Purpose. Estimating potentialities of perioperative monitoring of cerebral hemodynamics in endovascular interventions for cerebral AVM.

Material and Methods. Endovascular interventions were performed in 35 cases with AVM. Blood flow velocity in cerebral vessels and systemic blood pressure were monitored with Multi Dop X (DWL) and Finapres-2300 (Ohmeda). Functional eloquence of afferent vessel was determined by cerebral autoregulation, estimated pre- and postoperatively with a cuff test (ARI - an autoregulation index) and phase shift (PS) between spontaneous oscillations of blood flow velocity and systemic blood pressure within the range of M-waves and intraoperatively with a barbiturate test (BT).

Results. Total embolisation of AVM compartment was performed in 12 out of 30 cases with low functional eloquence of afferent vessel. ARI and PS before and after operation were 1.8±0.79 and 0.27±0.18 rad and 4.5±1.0 and 0.86±0.37 rad (p<0.05) respectively. Intraoperative BT was negative. The rest 18 cases underwent partial exclusion. ARI and PS before and after operation were 1.85±0.69 and 0.36±0.22 rad and 3.03±0.82 and 0.44±0.25 rad (p>0.05) respectively. Intraoperative BT was negative. There were no postoperative complications. Preoperative ARI and PS in 5 cases with high functional eloquence of afferent vessel were 4.33±0.58 and 0.63±0.16 rad (p<0.01). Embolization was not performed in 4 BT-positive cases. AVM compartment embolization caused persistent postoperative neurological deficit in 1 BT-negative patient.

Conclusion. Perioperative monitoring of cerebral hemodynamics in AVM ensures more effective estimation of functional eloquence of afferent vessel, better selection of cases for embolization and avoidance of postoperative neurological complications.