Significant venous flow alterations following brain arteriovenous malformation Surgery: Assessment by transcranial colour duplex

Kathryn Busch; Andrew Davidson; Antonio Di Ieva; Nazih Assaad; Mark Butlin; Alberto Avolio; Hosen Kiat

doi:10.1016/j.jocn.2022.03.023

Significant venous flow alterations following brain arteriovenous malformation Surgery: Assessment by transcranial colour duplex

J Clin Neurosci. 2022 May:99:268-274. doi: 10.1016/j.jocn.2022.03.023. Epub 2022 Mar 21.

Authors

Kathryn Busch¹, Andrew Davidson², Antonio Di Ieva³, Nazih Assaad⁴, Mark Butlin⁴, Alberto Avolio⁴, Hosen Kiat⁵

Affiliations

¹ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: kathryn.busch@sydneyvascular.net.au.
² Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia.
³ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia; Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Macquarie University, 2 Technology Place, Sydney, NSW 2109, Australia.
⁴ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia.
⁵ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Level 3, 75 Talavera Rd, Macquarie University, Sydney, NSW 2109, Australia; The Centre for Complementary Medicine Research, Western Sydney University, 158 Hawkesbury Rd, Westmead, NSW 2145, Australia.

PMID: 35325724
DOI: 10.1016/j.jocn.2022.03.023

Abstract

Brain arteriovenous malformation (bAVM) resection imposes several post-operative clinical challenges including intracranial haemorrhage (ICH). Daily non-invasive monitoring of haemodynamic measurements may be useful in predicting post-operative ICH. This prospective study used transcranial colour duplex (TCCD) and central aortic pressure (CAP) measurements to evaluate 15 bAVM patients pre-operatively and daily ≤ 14 days post-operatively. TCCD measurements of middle cerebral artery and veins included peak systolic (PSV), end diastolic (EDV), and pulsatility indices (PI). Parameters were compared with 7 craniotomy patients (non-bAVM craniotomy/surgical group). Normal reference values included 20 healthy volunteers. Significant middle cerebral vein MCV changes in bAVM patients occurred; Maximal PSV was significantly higher (median 47 cm/s) compared to non-bAVM craniotomy/surgical controls (median 17 cm/s, p = 0.0123); maximal PI was significantly higher (median 0.99, p = 0.005) compared to the non-bAVM craniotomy/surgical controls (median 0.49). In 8 of 15 patients, increased MCV velocity and pulsatility "stabilised" within 14 days post-operatively. Mean number of days for the 8 patients to reach stable state was 5.9 days, (range 0-9 days). To our knowledge, this is the first imaging study demonstrating significant venous changes post bAVM resection. Significant increased venous flow occurs in pial veins bilaterally. Increased pressure of venous flow is evidenced by a significant increase in diameter and pulsatility. Subsequently, haemorrhagic complications may be due distal constriction of the pial veins causing venous hypertension. The cause of the dilated vascular bed is unknown.

Keywords: Arteriovenous malformation; Brain; Colour duplex sonography; Hemodynamic; Pressure; Transcranial.

MeSH terms

Blood Flow Velocity
Brain
Color
Humans
Intracranial Arteriovenous Malformations* / complications
Intracranial Arteriovenous Malformations* / diagnostic imaging
Intracranial Arteriovenous Malformations* / surgery
Intracranial Hemorrhages / etiology
Prospective Studies