We describe a case in which jugular venous bulb oxygen saturation (Sjv
O2) monitoring proved useful during the surgical resection of an intra
cranial arteriovenous malformation (AVM). Surgical resection of large
intracranial AVMs may be followed by normal perfusion pressure breakth
rough with brain swelling, hyperemia, and subsequent problems in achie
ving hemostasis. SjvO2 monitoring during AVM embolization by intervent
ional radiology has been shown to help in deciding whether embolizatio
n is sufficient to avoid such postresection hyperemia, but its use dur
ing surgical resection has not been described. In the case discussed.
SjvO2 monitoring enabled assessment of the risk of postresection hyper
emia preoperatively and permitted the degree and completeness of surgi
cal AVM resection to be followed intraoperatively. During the normal p
erfusion pressure breakthrough bleeding which followed complete AVM re
section, SjvO2 monitoring helped with safe management of the controlle
d hypotension that finally permitted hemostasis to be achieved.