Abstract
An extremely rare case of arteriovenous malformation (AVM) in the region of the middle cerebral artery, the main trunk of which was occluded asymptomatically, is presented. Immediately followed by an uneventful excision of the entire AVM, a massive brain swelling occured unexpectedly. This was successfully treated with high-dose barbiturate therapy associated with other standard measures of controlling increased intracranial pressure. Based on this experience, the author stressed that massive intraoperative brain swelling possibly due to normal perfusion pressure breakthrough can also occur in patients with not so large AVMs, provided the preoperative impairment of autoregulation is severe enough. In addition, high-dose barbiturate therapy will be the method of choice for the treatment of massive intraoperative brain swelling.
