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*1. Normal Perfusion Pressure Breakthrough

First described in 1978 by Spetzler e al. [97], the hypothesis suggests that the parenchyma surrounding a high-flow AVM is chronically hypoperfused ; as a result, it has impaired autoregulation, rendering it vulnerable to the normal perfusion pressure likely to be seen following AVM resection.

Thus, following removal of an AVM, the local capillary beds and arterioles in the remaining normal parenchyma experience increased perfusion but lack the ability to vasoconstrict and auto regulate. This could lead, in some cases, to hyperemia, compromise of the capillary beds, and resultant edema and/or hemorrhage.

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