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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Brain Arteriovenous Malformations Located in Premotor Cortex: Surgical Outcomes and Risk Factors for Postoperative
Yuming Jiao1, Fuxin Lin2, Jun Wu1
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Objective:
The premotor cortex (PMC) is known to have a dual role in movement and language processing. Nevertheless, surgical outcomes of brain arteriovenous malformations located in PMC (PMC-BAVMs) have not been well defined. The aim of this study was to determine surgical outcomes and risk factors for neurologic deficits (NDs) after surgery in patients with PMC-BAVMs.
Methods:
We retrospectively reviewed patients with PMC-BAVMs who underwent surgical resection of the nidus. All patients had undergone preoperative functional magnetic resonance imaging, diffusion tensor imaging, magnetic resonance imaging, three-dimensional time-of-flight magnetic resonance angiography, and digital subtraction angiography. Functional and angioarchitectural factors were analyzed with respect to postoperative NDs. Function-related fiber tracts, corticospinal tract, and dominant arcuate fasciculus were tracked. Lesion-to-fiber distance was measured.
Results:
We identified 36 patients with PMC-BAVMs. Radical resection was achieved in all patients. Four patients (11.1%) presented with limb-kinetic apraxia and bradykinesia. Short-term NDs developed in 12 (33.3%) patients, among which 6 developed aphasias and 7 developed muscle weakness. A shorter lesion-to-eloquent fiber distance (P = 0.012) and larger nidus size (P = 0.048) were significantly associated with short-term NDs. Long-term NDs occurred in 5 patients. Larger nidus size was significantly associated (P = 0.015) with long-term NDs.
Conclusions:
Varying degrees of motor and language deficits can be induced immediately after resection of PMC-BAVMs. Permanent and long-term severe motor or language deficits are rare. Shorter lesion-to-eloquent fiber distance is a risk factor for short-term NDs. Larger nidus size is a risk factor for short-term and long-term NDs.
Insights
Surgical resection of premotor cortex arteriovenous malformations (PMC-AVMs) can cause temporary motor and language deficits. Larger AVM size and proximity to critical pathways increase risks, but permanent deficits are rare after PMC-AVM surgery.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- The premotor cortex (PMC) plays a crucial role in both motor control and language processing.
- Surgical outcomes for brain arteriovenous malformations (BAVMs) within the PMC (PMC-BAVMs) are not well-established.
- Understanding risks associated with PMC-BAVM resection is vital for patient management.
Purpose of the Study:
- To evaluate surgical outcomes in patients with PMC-BAVMs.
- To identify risk factors for postoperative neurologic deficits (NDs) following PMC-BAVM resection.
Main Methods:
- Retrospective review of 36 patients undergoing surgical resection of PMC-BAVMs.
- Preoperative imaging included fMRI, DTI, MRI, MRA, and DSA.
- Analysis of functional and angioarchitectural factors, including lesion-to-eloquent fiber distance and nidus size, in relation to NDs.
Main Results:
- All 36 patients achieved radical resection.
- Short-term NDs occurred in 33.3% of patients (aphasia, muscle weakness).
- Shorter lesion-to-eloquent fiber distance and larger nidus size were significant predictors of short-term NDs. Larger nidus size also predicted long-term NDs.
Conclusions:
- Resection of PMC-BAVMs can lead to transient motor and language impairments.
- Permanent severe deficits are uncommon after PMC-BAVM surgery.
- Lesion proximity to eloquent fibers and nidus size are key factors influencing surgical risk.
