Hemodynamic aspects of cerebral arteriovenous malformations

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Abstract
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 3-550 ml/min (average, 180 ml/min). An estimation of total AVM flow was possible in 9 patients and ranged from 150 to > 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 40-77 mm Hg (average, 56 mm Hg). On temporary occlusion, this stump pressure instantly rose from 55-95 mm Hg (average, 76 mm Hg). Draining vein pressure before occlusion ranged from 8-23 mm Hg (average, 15 mm Hg) and fell to 0 when the AVM was occluded. This data and other clinical observations are discussed with regard to adjacent brain-tissue perfusion, with special emphasis on the circulatory breakthrough that can follow the occlusion of these high-capacity shunts.