One-stage excision of high-flow arteriovenous malformations

The authors describe two cases of high-flow arteriovenous malformations which illustrate a new technique to reduce the risk of brain swelling and diffuse hemorrhage during or after operation. This technique, used in the latter of the two cases, includes occlusion of the shunt, followed by the progressive tightening of a Selverstone clamp placed on the cervical internal carotid artery, lowering of the systemic arterial pressure, and the use of barbiturate anesthesia. Clamping and anesthesia are maintained for a 24-hour period after surgery.