Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
Normal perfusion pressure breakthrough is a potentially catastrophic event after arteriovenous malformation (AVM) surgery. Anesthesia providers should strive for tight perioperative blood pressure control and should be vigilant for signs of postoperative neurologic deterioration. This chapter presents a case study of a 37-year-old female with a 2-month history of generalized tonic-clonic seizures. The patient underwent a successful left craniotomy for clipping and resection of an AVM located in the left parietooccipital lobe. Emergent computed tomography (CT) scan of the brain showed massive cerebral edema, as well as enlarged vascular enhancement suggesting hyperperfusion and a small intracerebral hemorrhage. One month after surgery, examination demonstrated no neurologic deficit and a cerebral angiography showed normalization of flows and diameter of the left posterior cerebral artery. Neuroimaging evidence of normal pattern of cerebral vasoreactivity along with neurologic status improvement may warrant barbiturate withdrawal and careful liberalization of the blood pressure control.
1.A. R.Rezai, B. H.Kopell, R. E.Grosset al. Deep brain stimulation for Parkinson's disease: surgical issues. Mov Disord2006; 21: S197–218.
2.P.Krack, V.Fraix, A.Mendeset al. Postoperative management of subthalamic nucleus stimulation for Parkinson's disease. Mov Disord2002; 17: S188–97.
3.J. G.Nutt, S. L.Rufener, J. H.Carteret al. Interactions between deep brain stimulation and levodopa in Parkinson's disease. Neurology2001; 57: 1835–42.
4.J. G.Pilitsis, A. R.Rezai, N. M.Bouliset al. A preliminary study of transient confusional states following bilateral subthalamic stimulation for Parkinson's disease. Stereotact Funct Neurosurg2005; 83: 67–70.
5.A. R.Rezai, A. G.Machado, M.Deogaonkaret al. Surgery for movement disorders. Neurosurgery2008; 62: 809–38.