Abstract: There are clearly cases of severe complications after giant AVMs resection, such as brain swelling and hemorrhage. In 1978, "normal perfusion pressure breakthrough, NPPB" has been termed by Dr. Spetzler. The incidence of NPPB is 1%～10%. The surgical management of giant AVMs previously has been associated with an unacceptably high incidence of complications. In the literature, the combined mortality and serious morbidity for resection has approached 50% in the literatures. In our study, that the combination of intraoperative embolization with surgical resection for treatment of giant cerebral AVMs. Pre-and postoperative changes of regional cortical cerebral blood flow in patients with cerebral AVMs. The embolization could block the arteniovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain, so as to prevent the incidence of intra-and postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in treatment of giant cerebral AVMs.

Key words: arteriovenous malformations, normal perfusion pressure breakthough, surgical resection