Cortical Spreading Depolarization bei der chirurgischen Behandlung von zerebralen arteriovenösen Malformationen und arteriovenösen Fisteln

Spreading Depolarization (SD) is characterized by a wave of neuronal and astrocytic mass depolarization, causing severe disruptions in ion homeostasis and leading to altered local cerebral blood flow. This phenomenon is notably linked to the secondary progression of lesions in acute pathologies such as traumatic brain injury, hemorrhagic stroke, and cerebral ischemia.

Cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVF) represent pathological vascular anomalies characterized by abnormal arterio-venous anastomoses, bypassing the typical intervening capillary network. This results in altered hemodynamics and an increased risk of hemorrhage. Despite the description of SD in chronic diseases like migraine and Moyamoya disease, there is currently no direct evidence for the occurrence of SDs in patients with AVMs or AVFs.

Using intraoperative Laser Speckle Contrast Imaging, cortical perfusion was recorded in nine patients undergoing surgical AVM resection and two patients with surgical AVF treatment.

Interestingly, spontaneous SD activity was observed in 2 patients. One patient was undergoing AVM resection, whereas the in the other patient, a AVF was surgically treated. Within those two patients, at least 4 SDs were observed and all SDs were associated with local hyperperfusion.

By employing intraoperative laser speckle perfusion measurement, spontaneous intraoperative SD activity was observed for the first time during the treatment of AVM and AVF. SDs could potentially be triggered by the altered hemodynamics induced by surgical interventions. Furthermore, SD might play a role in the pathomechanism of symptoms related to AVM and AVF and should be considered in the postoperative phase of these pathologies.