POSTOPERATIVE HYPERPERFUSION IN DURAL ARTERIOVENOUS-FISTULA ASSOCIATED WITH VENOUS ISCHEMIA - CASE-REPORT

BACKGROUND It is well known that carotid endarterectomy and extracrani al-intracranial arterial bypass sometimes cause postoperative hyperper fusion, and vasoparalysis attributable to long-standing ischemia has b een suggested as the cause. It is also well known that dural arteriove nous fistula (AVF) sometimes causes cerebral ischemia attributable to venous hypertension. However, there are few reports regarding the post operative changes of regional cerebral blood flow (rCBF). METHODS We r eport a case of dural AVF of the left transverse/sigmoid sinuses, occu rring in a 64-year-old man. Intraoperative transvenous embolization co mbined with transarterial embolization was performed, and the rCBF was measured pre-and postoperatively using Tc-99m-hexamethyl-propylene am ine oxime and single-photon emission computed tomography (SPECT). RESU LTS Preoperative SPECT disclosed a marked rCBF reduction in the left t emporal, parietal, and occipital lobes. Complete obliteration of the A VF was attained after the intraoperative transvenous embolization, wit hout any neurological deterioration. However, postoperative SPECT temp orary hyperperfusion in these regions. CONCLUSIONS Sudden resolution o f venous ischemia can lead to postoperative hyperperfusion, and pre-an d post-treatment rCBF studies are important to prevent complications r elated to hyperperfusion. (C) 1998 by Elsevier Science Inc.