CONTROL OF HEMORRHAGE DURING AVM SURGERY - WITH SPECIAL REFERENCE TO TREATMENT OF DILATED CAPILLARIES AND ARTERIES AROUND THE NIDUS

Control of hemorrhage during AVM surgery is one of the key issues to p revent NPPB. inadequate procedures for hemostasis of feeders and drain ers, socalled dilated capillaries and arteries (moja moja blood vessel s) that are located on the side facing the normal brain, and inappropr iate surgical strategies for intraoperative hemorrhage from these bloo d vessels are frequently the main cause of the difficulty in achieving hemostatic control. We conclude that it is important to aggressively reduce the occurrence of intraoperative hemorrhage and prevent or mini mize the dilatation of abnormal capillaries and arteries due to inappr opriate surgical procedures on the basis of the fundamental surgical s trategy, i.e., feeder --> nidus --> drainer. Adequately securing the l ength and adequate coagulation of hemorrhagic blood vessel, employing a skillful bipolar coagulator technique aimed at controlling intralumi nal pressure and blood flow on the central side, are believed to be ke y factors in hemorrhage treatment.