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Posts Tagged ‘intracranial arteriovenous malformations

Ahead of Print: Safe Resection of Arteriovenous Malformations in Eloquent Motor Areas Aided by Functional Imaging and Intraoperative Monitoring

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BACKGROUND: Arteriovenous malformations (AVMs) proximal to motor cortical areas or motor projection systems are challenging to manage due to the risk of severe sensory and motor impairment. Surgical indication in these cases therefore remains controversial.

OBJECTIVE: To propose a standardized approach for centrally situated AVMs, based on functional imaging and intraoperative electrophysiological evaluation.

METHODS: We conducted a retrospective analysis of 15 patients who underwent surgical treatment for AVMs in motor cortical areas or proximal to motor projections. Preoperative assessment included fMRI and 3D-tractography. Operations were performed under continuous electrophysiological monitoring aided by direct brain stimulation. We identified critical bloody supply to the motor areas by temporary occluding the feeding vessels under electrophysiological monitorization. Clinical outcome was evaluated using the modified Rankin Scale.

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Written by NEUROSURGERY® Editorial Office

October 24, 2011 at 3:07 PM

Editor Choice: Treatment of Giant Cerebral Arteriovenous Malformation: Hypofractionated Stereotactic Radiation as the First Stage

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Xiao, Furen MD

BACKGROUND: Treatment of giant cerebral arteriovenous malformations (AVMs) remains a challenge.

OBJECTIVE: To propose hypofractionated stereotactic radiotherapy (HSRT) as a part of staged treatment, and evaluate its effect by analyzing AVM volume changes.

METHODS: From 2001 to 2007, 20 AVMs larger than 5 cm were treated by HSRT and followed up using magnetic resonance imaging. Patients’ median age was 34 years (8–61 years). Eleven patients presented with hemorrhage and 9 with seizure. Ten patients had previous embolization and radiosurgery had failed in 4. Thirteen AVMs (65%) were classified as Spetzler-Martin grade V and 7 as grade IV. Median pretreatment volume was 46.84 cm3(12.51-155.38 cm3). Dose was 25 to 30 Gy in 5 to 6 daily fractions. Median follow-up was 32 months.

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Written by NEUROSURGERY® Editorial Office

November 1, 2010 at 9:04 AM

Editor Choice: How Safe Is Arteriovenous Malformation Surgery? A Prospective, Observational Study of Surgery As First-Line Treatment for Brain Arteriovenous Malformations

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Davidson, Andrew S. MS; Morgan, Michael K. MD

OBJECTIVES: Existing studies reporting the risk of surgery for brain arteriovenous malformations (AVMs) are often biased by the exclusion of patients not offered surgery. In this study, we examine the risk of surgery, including cases excluded from surgery because of the high surgical risk.

METHODS: Data were collected on 640 consecutively enrolled AVMs in a database that included all patients not considered for surgery.

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Written by NEUROSURGERY® Editorial Office

February 24, 2010 at 9:00 AM


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