Resection of a large arteriovenous fistula of the brain using low-flow deep hypothermic cardiopulmonary bypass: Technical case report

Bernard R. Bendok, Christopher C. Getch, James Frederiksen, H. Hunt Batjer

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

OBJECTIVE AND IMPORTANCE: We present the second report in the literature on the use of low-flow hypothermic cardiopulmonary bypass to aide in the surgical resection of a large intraparenchymal arteriovenous fistula. CLINICAL PRESENTATION: The patient was a 46-year-old man who was found to have a left sylvian arteriovenous fistula with a giant varix during a workup for chronic left frontal headaches and was referred to our center for management. A cardiac workup revealed a cardiac output of 9 L per minute. INTERVENTION: Endovascular embolization of the lesion was initially attempted without success because of the high flow within the lesion and the large diameter of the feeding arteries. We then planned combined and staged endovascular and surgical approaches to gradually eliminate the fistula. Endovascular embolization, both transarterial and transvenous, could not be performed because of the high flow in the fistula. Despite the stepwise reduction of flow during the course of several weeks via surgical exposures and arterial ligations, the fistula remained difficult to remove because of its size and the turgor of the varix. Once hypothermic low-flow circulatory bypass was used, however, decompression of the sac allowed access to the afferent vasculature. CONCLUSION: The use of low-flow hypothermic circulatory bypass can facilitate the surgical extirpation of certain large intraparenchymal arteriovenous fistulas.

Original languageEnglish (US)
Pages (from-to)888-891
Number of pages4
JournalNeurosurgery
Volume44
Issue number4
DOIs
StatePublished - Apr 1999

Keywords

  • Arteriovenous fistula
  • Low-flow hypothermic circulatory bypass

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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