Brain arteriovenous malformations located in premotor cortex: Surgical outcomes and risk factors for postoperative neurological deficits.

Brain arteriovenous malformations located in premotor cortex: Surgical outcomes and risk factors for postoperative neurological deficits.

World Neurosurg. 2017 Jun 02;:

Authors: Jiao Y, Lin F, Wu J, Li H, Chen X, Li Z, Ma J, Cao Y, Wang S, Zhao J

Abstract
OBJECT: The premotor cortex (PMC) is known to have a dual role in both movement and language processing. Nevertheless, surgical outcomes of premotor cortex BAVMs (PMC-BAVMs) have not been well-defined. The aim of this study was to determine the surgical outcomes and risk factors for neurological deficits (ND) 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 MRI (fMRI), diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA). Both functional and angioarchitectural factors were analysed with respect to the postoperative ND. Function-related fibre tracts, corticospinal tract (CST) and dominant arcuate fasciculus (AF) were tracked. Lesion-to-fibre distance was measured.
RESULTS: Thirty-six patients with PMC-BAVMs were identified. Radical resection was achieved in all patients. Four patients (11.1%) presented with limb-kinetic apraxia and bradykinesia. Twelve (33.3%) patients developed short-term ND, among which six developed aphasias and seven developed muscle weakness. A shorter LFD (p = 0.012) and larger nidus size (p = 0.048) were significantly associated with short-term ND. Five patients suffered from long-term ND. Larger nidus size was significantly associated (p = 0.015) with long-term ND.
CONCLUSIONS: Varying degrees of motor and language deficits can be induced immediately after resection of PMC-BAVMs. Permanent and severe motor or language deficit rarely remains for the long term. Shorter lesion-to-eloquent fibre distance (LFD) is a risk factor for short-term ND. Larger nidus size is a risk factor for short-term and long-term ND.

PMID: 28583455 [PubMed - as supplied by publisher]

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