Evidence of redistribution of cerebral blood flow during treatment for an intracranial arteriovenous malformation.
Evidence of redistribution of cerebral blood flow during treatment for an intracranial arteriovenous malformation.
复制标题
颅内动静脉畸形治疗期间脑血流重新分布的证据。
作者：
H. Batjer;P. Purdy;Cole A. Giller;D. Samson
颅内动静脉畸形的存在对局部循环动力学有很大影响。一些动静脉畸形的治疗可能会导致灾难性的充血状态，这是由于先前分流的血液重新分配造成的。本报告描述了3例动静脉畸形患者治疗过程中的脑血流和血流速度的动态测量。使用稳定的氙气吸入技术进行CT扫描，测量脑血流量；经颅多普勒超声测量血流速度，包括自动调节特性。1例患者(例1)切除后出现大量充血，另1例(例3)经栓塞术后出现严重充血。1例治疗前出现低灌注者，经栓塞术后局部脑血流量恢复正常(例2)。在患者1中，术后充血与持续升高的血流速度有关，并可能伴有半球神经功能障碍。连续的血流动力学测量可以预测患者有围术期并发症的风险，并可能成为指导栓塞的范围和时机以及颅内出血或术前栓塞术后手术时机的有用临床指南。
The presence of an intracranial arteriovenous malformation has a dramatic impact on local circulatory dynamics. Treatment of some arteriovenous malformations can result in disastrous hyperemic states caused by redistribution of previously shunted blood. This report describes serial hemodynamic measurements of both cerebral blood flow and flow velocity in 3 patients during treatment for arteriovenous malformations. Measurements of cerebral blood flow were made by computed tomographic scan employing the stable xenon inhalation technique; flow velocity, including autoregulatory characteristics, was measured by transcranial Doppler ultrasonogram. Substantial hyperemia developed in one patient (Case 1) after resection and in another (Case 3) after embolization. Embolization resulted in restoration of normal regional cerebral blood flow in a patient who demonstrated hypoperfusion before treatment (Case 2). In Patient 1, postoperative hyperemia was associated with persistently elevated flow velocities, and may have been accompanied by hemispheric neurological deficits. Sequential hemodynamic measurements may predict patients at risk of perioperative complications, and may become useful clinical guidelines for the extent and timing of embolization and for the timing of surgery after intracranial hemorrhage or preoperative embolization procedures.