[A case of arteriovenous malformation successfully treated with functional mapping of the language area by PET...

The authors report a case of temporal AVM safely treated by mapping the language area with PET activation study. The patient was a 50-year-old woman with temporal epilepsy as her chief complaint. MRI and angiography revealed a right temporal AVM. Before surgical treatment, we assessed the dominant hemisphere with PET activation study. We performed PET scanning while the patient was playing "capping" (called "Shiritori" in Japanese), from which we subtracted PET images performed when she was in a resting state, and then we superimposed those images upon MRIs. The blood flow increased in the left frontal operculum (Broca's area), the left caudal head, the left putamen and the right cerebellar hemisphere. We were thus able to determine that her left hemisphere was dominant, and that it was safe to undertake embolization and operation for the AVM. Postoperative course was uneventful and higher cortical functions were preserved perfectly. In cases of cerebral AVMs, unusual dominancy of cerebral hemispheres is often encountered, and so, preoperative evaluation of the relation of AVM to the eloquent cortex is essential. In our study, blood flow increased in some areas other than the language area, but they were considered to be areas related to phonation, and we think that we were able to map the language area. Though this method is still in its preliminary stage, we think it gives us useful information for surgical treatment of cerebral AVMs.