Does eloquence subtype influence outcome following arteriovenous malformation surgery?

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Arteriovenous malformations (AVMs) grading scales often incorporate eloquence, but lack differentiation between eloquence subtypes.
• The impact of specific eloquence subtypes on clinical outcomes after AVM treatment remains unclear.

Purpose of the Study:

• To investigate whether different subtypes of brain AVM eloquence affect clinical outcomes following microsurgical intervention.

Main Methods:

• Retrospective review of 241 patients with eloquent brain AVMs treated between 1997 and 2017.
• Preoperative categorization of eloquence by radiologists based on Spetzler-Martin grading scale definitions.
• Logistic regression analysis to determine factors associated with poor outcomes (modified Rankin Scale score 3-6).

Main Results:

• Sensorimotor (46.1%) and language (22.0%) eloquence subtypes were significantly associated with poor outcomes compared to visual eloquence (27.0%).
• Older age and larger AVM size also correlated with worse clinical outcomes.
• No significant differences in baseline patient or AVM characteristics were observed among eloquence subtypes.

Conclusions:

• Sensorimotor and language eloquence subtypes are associated with worse clinical outcomes after AVM resection than visual eloquence.
• This nuanced understanding of AVM eloquence is critical for surgical decision-making, particularly for borderline cases.
• Consideration of eloquence subtypes can refine risk assessment in AVM management.