Abstract
When a large cerebral arteriovenous malformation (AVM) is operated on, massive multi-focal bleeding, the so called normal perfusion pressure breakthrough (NPPB), represents a frightening and usually catastrophic complication. However recently we encountered a case of a large AVM which exhibited NPPB near the end of an operation and postoperative intracerebral hematoma. The patient was given an immediate second operation under barbiturate protection and induced hypotension and the patient's post operative course was uneventful. The large AVM was completely removed. This case emphasizes the usefulness of barbiturate administration and induced hypotension at the intra and postoperative management of NPPB.
