IJCNMH ARCpublishing

Issue: Issue 1 (2014) – Supplement 1

Original Article

Capability of cerebral autoregulation assessment in arteriovenous malformations perinidal zone

Vladimir Semenyutin, Grigory Panuntsev, Vugar Aliev, Andreas Patzak, Dmitry Pechiborsch, and Alexandr Kozlov
Background: Cerebral autoregulation (CA) in the region of an intracranial artery involved in blood supply of arteriovenous malformations (AVM) is impaired. This could be due to pathologic shunting, disguising real state of CA, or brain lesion in perinidal area. It is quite difficult to define the influence of both factors on CA. The purpose of this study was to assess dynamics of CA in patients with AVM in perioperative period.

Methods: The radicality of AVM embolization (Hystoacryl or Onyx) was evaluated in 47 patients by cerebral angiography and blood flow index in precerebral arteries with a Vivid E ultrasound scanner. We monitored blood flow velocity (BFV) in basal cerebral arteries with Multi Dop X and blood pressure (BP) with Finapres-2300. CA was assessed with cuff test (autoregulation index – ARI) and phase-shift (PS) between spontaneous oscillations of BP and BFV within the range of Mayer’s waves.

Results: Preoperative values of ARI and PS were 1.8±0.7 and 0.3±0.2 rad, respectively. In 15 cases with total embolization a significant (p<0.005) increase of rate of CA (ARI: 6.0±1.1, PS: 0.9±0.1 rad) was noted. In other two cases with total embolization, CA didn’t change significantly after operation. In 14 cases with subtotal embolization postoperative ARI and PS were 3.6±0.5 and 0.7±0.1 rad, respectively (p<0.05), and in cases with partial elimination were 2.1±0.6 and 0.4±0.1 rad (p>0.05).

Conclusion: CA assessment could be used for detection of its real impairment in perinidal zone of AVM during the staged endovascular treatment and for prognostication of postoperative complications.

Keywords: Cerebral autoregulation, Cerebral blood flow volume, Arteriovenous malformation, Embolization.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S19

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