JUGULAR VENOUS BULB OXYGEN-SATURATION MONITORING IN ARTERIOVENOUS MALFORMATION SURGERY

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.