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.

Editor Choice: A Real-Time Monitoring System for the Facial Nerve

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Prell, Julian MD; Rachinger, Jens MD; Scheller, Christian MD; Alfieri, Alex MD; Strauss, Christian MD; Rampp, Stefan MD

OBJECTIVE: Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter “traintime,” which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time.

METHODS: A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma.

Ahead of Print: A Real-Time Monitoring System for the Facial Nerve

Full article access for Neurosurgery subscribers.

Prell, Julian MD; Rachinger, Jens MD; Scheller, Christian MD; Alfieri, Alex MD; Strauss, Christian MD; Rampp, Stefan MD

OBJECTIVE: Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter “traintime,” which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time.

METHODS: A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma.