Normal Perfusion Pressure Breakthrough Theory: A Reappraisal After 35 Years
The intrinsic ability of the brain to maintain constant cerebral blood flow (CBF) is known as cerebral pressure autoregulation. This ability protects the brain against cerebral ischemia and hyperemia within aÂ certain range of blood pressures. The normal perfusion pressure breakthrough (NPPB) theory described by Spetzler in 1978 was adopted to explain the edema and hemorrhage that sometimes occur after resection of brain arteriovenous malformations (AVMs). The underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. Over the last three decades, advances in neuroimaging, CBF, and cerebral perfusion pressure (CPP) measurement have bothÂ favored and contradicted the NBBP theory. At the same time, other theories have been proposed, including the occlusive hyperemia theory. We believe that both theories are related and complementary and thatÂ they both explain changes inÂ hemodynamics after AVM resection. The purpose of this work is to review the current status of the NBBP theory 35Â years after its original description.
Digital Object Identifier (DOI)
Rangel-Castilla, Leonardo; Spetzler, Robert F.; and Nakaji, Peter, "Normal Perfusion Pressure Breakthrough Theory: A Reappraisal After 35 Years" (2015). Neurosurgery. 294.