Purpose: To evaluate the use of cardiopulmonary bypass (CPB) in the resection of very large craniofacial vascular malformations (CVMs).

Methods: This was a consecutive case series of all patient at McGill, who had CVMs resected with the utilization of CPB. Charts were reviewed for (1) preoperative angiograms and embolizations, (2) operative bypass parameters, (3) short and long term complications

Results: CPB was used in the resection of 10 CVMs from 1989-2002. Ages ranged from 2 to 33. Indication for bypass, was either a significant venous component, or incomplete superselective angiographic embolization of the CVM due to a risk of functional loss. Procedures were conducted via either an open bypass (8 cases), or a closed femoral approach (2 cases). Patients either underwent circulatory arrest (2 cases), or were operated with a low flow state alone (8 cases). There were 3 postoperative complications. All patients went on to full recovery. The average length of postoperative stay was 10 days.

Conculsions: CPB is a useful procedure in the resection of selected cases of very large CVMs. The use of complete circulatory arrest was not required in the majority of cases, and an adequate resection was usually possible in a low flow state alone.