Clipping of the anterior communicating artery to eliminate the contralateral blood supply in supratentorial large AVM of the carotid system. A report of 22 cases.

Large supratentorial arteriovenous malformations (AVMs) of the carotid system are vascularized by the ipsilateral internal carotid artery (ICA) and often, in addition, by the contralateral ICA via the anterior communicating artery (ACoA). In these AVMs we have previously advocated (1981) multiple staged operations with the progressive reduction of the blood stream passing through the AVM. In twenty-two cases, starting in 1983, the reduction of the blood stream into the shunt has been performed as a first operation by placing a clip on the middle of the ACoA through a pterional approach on the opposite side of the AVM before radical open surgery. Results were excellent when considering the control angiogram and the measurement of the blood velocity in the ICA opposite to the AVM side. There were no neurological complications and no mortality.