Modern Treatment of Brain Arteriovenous Malformations Using Preoperative Planning Based on Navigated Transcranial Magnetic Stimulation: A Revisitation of the Concept of Eloquence.
Adult
Aged
Anatomic Landmarks
/ physiology
Brain Mapping
/ methods
Diffusion Tensor Imaging
Female
Functional Laterality
/ physiology
Humans
Intracranial Arteriovenous Malformations
/ therapy
Male
Middle Aged
Motor Cortex
/ physiology
Patient Care Planning
Preoperative Care
/ methods
Transcranial Magnetic Stimulation
/ methods
Treatment Outcome
Visual Pathways
/ physiology
Arteriovenous malformations
Diffusion tensor imaging
Eloquent areas
Language areas
Motor area
Navigated transcranial magnetic stimulation
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
10
05
2019
revised:
12
06
2019
accepted:
13
06
2019
pubmed:
28
6
2019
medline:
28
1
2020
entrez:
28
6
2019
Statut:
ppublish
Résumé
Navigated transcranial magnetic stimulation (nTMS) provides a reliable identification of "eloquent" cortical brain areas. Moreover, it can be used for diffusion tensor imaging fiber tracking of eloquent subcortical tracts. We describe the use of nTMS-based cortical mapping and diffusion tensor imaging fiber tracking for defining the "eloquence" of areas surrounding brain arteriovenous malformations (BAVMs), aiming to improve patient stratification and treatment. We collected data of BAVMs suspected to be in eloquent areas treated between 2017 and 2019, and submitted to nTMS-based reconstruction of motor, language, and visual pathways for the definition of the eloquence of the surrounding brain areas. We describe the nTMS-based approach and analyze its impact on patient stratification and allocation to treatment in comparison with the standard assessment of eloquence based on anatomical landmarks. Ten patients were included in the study. Preliminarily, 9 BAVMs were suspected to be located in an eloquent area. After nTMS-based mapping, only 5 BAVMs were confirmed to be close to eloquent structures, thus leading to a change of the score for eloquence and of the final BAVMs grading in 60% of patients. Treatment was customized according to nTMS information, and no cases of neurological worsening were observed. Radiological obliteration was complete in 7 cases microsurgically treated, and accounted for about 70% in the remaining 3 patients 1 year after radiosurgical treatment. The nTMS-based information allows an accurate stratification and allocation of patients with BAVMs to the most effective treatment according to a modern, customized, neurophysiological identification of the adjacent eloquent brain networks.
Sections du résumé
BACKGROUND
BACKGROUND
Navigated transcranial magnetic stimulation (nTMS) provides a reliable identification of "eloquent" cortical brain areas. Moreover, it can be used for diffusion tensor imaging fiber tracking of eloquent subcortical tracts. We describe the use of nTMS-based cortical mapping and diffusion tensor imaging fiber tracking for defining the "eloquence" of areas surrounding brain arteriovenous malformations (BAVMs), aiming to improve patient stratification and treatment.
METHODS
METHODS
We collected data of BAVMs suspected to be in eloquent areas treated between 2017 and 2019, and submitted to nTMS-based reconstruction of motor, language, and visual pathways for the definition of the eloquence of the surrounding brain areas. We describe the nTMS-based approach and analyze its impact on patient stratification and allocation to treatment in comparison with the standard assessment of eloquence based on anatomical landmarks.
RESULTS
RESULTS
Ten patients were included in the study. Preliminarily, 9 BAVMs were suspected to be located in an eloquent area. After nTMS-based mapping, only 5 BAVMs were confirmed to be close to eloquent structures, thus leading to a change of the score for eloquence and of the final BAVMs grading in 60% of patients. Treatment was customized according to nTMS information, and no cases of neurological worsening were observed. Radiological obliteration was complete in 7 cases microsurgically treated, and accounted for about 70% in the remaining 3 patients 1 year after radiosurgical treatment.
CONCLUSIONS
CONCLUSIONS
The nTMS-based information allows an accurate stratification and allocation of patients with BAVMs to the most effective treatment according to a modern, customized, neurophysiological identification of the adjacent eloquent brain networks.
Identifiants
pubmed: 31247351
pii: S1878-8750(19)31671-7
doi: 10.1016/j.wneu.2019.06.119
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
371-384Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.