Hypothermia and cardiopulmonary bypass during resection of extensive arteriovenous malformation followed by microvascular reconstruction.

A patient is presented in whom hypothermic hypoperfusion and cardiopulmonary bypass were used to aid in resection of a mandibular arteriovenous malformation. This was followed by immediate microvascular reconstruction using a fibular osteocutaneous microvascular free tissue transfer. Prior attempted resection after highly selective embolization had proved inadequate. We found that the operative field, using hypothermic hypoperfusion was bloodless and enabled safe, rapid excision of the malformation. After patient rewarming, microvascular reconstruction was readily performed. No neurologic sequelae resulted, and no recurrence of the malformation has been noted.