THE USE OF INTRAARTERIAL PAPAVERINE IN THE MANAGEMENT OF VASOSPASM COMPLICATING ARTERIOVENOUS MALFORMATION RESECTION

The authors report two cases of treatment by intraarterial papaverine of cerebral vasospasm complicating the resection of an arteriovenous m alformation (AVM). Both cases had successful reversal of vasospasm doc umented on angiography. In the first case sustained neurological impro vement occurred, resulting in a normal outcome by the time of discharg e. In the second case, neurological deterioration occurred with the de velopment of cerebral edema. This complication was thought to be due t o normal perfusion pressure breakthrough, on the basis of angiographic arterial vasodilation and increased cerebral blood flow. These two ca ses illustrate an unusual complication of surgery for AVMs and demonst rate that vasospasm (along with intracranial hemorrhage, venous occlus ion, and normal perfusion pressure breakthrough) should be considered in the differential diagnosis of delayed neurological deterioration fo llowing resection of these lesions. Although intraarterial papaverine may be successful in dilating spastic arteries, it may also result in pathologically high flows following AVM resection. However, this compl ication has not been seen in our experience of treating aneurysmal sub arachnoid hemorrhage by this technique.