Angiographic Control During Total Excision of a Cerebral Arteriovenous Malformation

Received for publication November 2, 1967. Examinat ion . There was minimal spastic weakness of the left arm and leg. The ocular fundi were normal, visual fields full, and visual acuity 6 / 6 for both eyes. Skull x-rays were normal. The electroencephalogram showed bursts of spikes and sharp waves on a background of delta and theta activity over the right frontotemporal region. In spite of heavy anticonvulsive medication, the patient continued to have epileptic fits on most days. Operation. On July 27, 1967, under endotracheal anesthesia, a right frontotemporal flap was turned down. Controlled respiration and Mannitol were used. The carotid artery was exposed in the neck. A polyethylene PE 160 catheter was advanced into the internal carotid artery for angiographic control during operation. When the dura was opened a brownish discoloration of the prefrontal cerebral cortex was noted. The cortex was incised near the point of convergence of three abnormally large arte-