RESECTION OF A LARGE, HIGH-FLOW ARTERIOVENOUS MALFORMATION DURING HYPOTENSION AND HYPOTHERMIA INDUCED BY A PERCUTANEOUS CARDIOPULMONARY SUPPORT SYSTEM - CASE-REPORT

The key to successful surgical resection of cerebral arteriovenous mal formations (AVMs) is control of bleeding and cerebral swelling. Induce d hypotension is one of the most valuable means of achieving this cont rol. The authors introduced induced hypotension with mild hypothermia by using a percutaneous cardiopulmonary support system (PCPS) to resec t a large, high-flow AVM. The efficacy and technical points of this me thod are discussed. The PCPS, whose entire intraluminal surface was co ated with heparin, was established through a transfemoral route. Durin g resection of the AVM, a mean arterial blood pressure of 60 mm Hg and a mean body temperature of 30 degrees C were easily maintained by reg ulating the flow rate of the PCPS and by blood cooling. The activated coagulation time was maintained at approximately 250 seconds with a mi nimum systemic administration of heparin. The authors report the case of a 30-year-old woman who presented with intraventricular hemorrhage and was diagnosed as having a large, high-flow AVM located in the left sylvian fissure. The AVM was fed by the left middle, posterior, and a nterior cerebral arteries and drained by the many cortical ascending v eins and the basal vein. The patient underwent surgery after hypotensi on and hypothermia had been induced via the PCPS method. Induced hypot ension decreased the tension of the nidus and made its dissection easi er. The AVM was totally resected and no hemostatic difficulties were e ncountered. On the basis of the authors' experience, they suggest that : hypotension and hypothermia induced by using the PCPS is a powerful tool for the successful resection of large, high-flow AVMs.