Abstract
Patients who have a cerebral arteriovenous malformation (cAVMs) in the motor cortex can have displaced function. The finding and its relationship to recovery from surgery is not known. We present the five cases with cAVMs involving precentral knob and/or paracentral lobule and without preoperative motor deficits. We used motor activation areas derived from Functional functional MRI (fMRI) as a region of interesting (ROI) to launch the plasticity of cerebrospinal tracts (CST). All the results were incorporated into the neuronavigation platform for surgical treatment. Intraoperative electric cortical stimulation (ECS) was used to map motor areas. Modified Rankin Scale (mRS) of hands and feets were performed on postoperative day 2, 7 and at month 3, 6 during follow-up period. All the patients suffered from motor deficits regardless of cortical activation patterns. Three patients showed functionally seeded CST in or around the AVM, and were validated by intraoperative electrical stimulation (ECS). Patient 4 had two aberrant functionally seeded fiber tracts away from the lesion, but were proved to be non-functional by postoperative motor deficits. Patient 3 with motor cortex and fiber tract within a diffuse AVMs nidus, complete paralysis of upper extremity after operation and has a persistent motor deficit during 6-month follow-up period. The plasticity of motor cortex on fMRI doesn’t prevent post-operative motor deficits. Functionally mapped fiber tract within or abutting AVM nidus predicts transient and persistent motor deficit.
Highlights
Patients who have a cerebral arteriovenous malformation in the motor cortex can have displaced function
We focused on intraoperative electric cortical stimulation (ECS) to validate plasticity of motor cortex/fiber and determine the correlation of
The activation areas elicited by right foot movement reorganized obviously at the anterior part of the paracentral lobule and supplementary motor area (SMA) compared with that in contralateral hemisphere (Fig. 3)
Summary
Patients who have a cerebral arteriovenous malformation (cAVMs) in the motor cortex can have displaced function. The finding and its relationship to recovery from surgery is not known. Cerebral arteriovenous malformations (cAVMs) may grow in eloquent areas such as the motor cortex, patients with a cAVMs usually do not present with neurological deficits unless it has ruptured. It has been postulated that when these lesions develop in the usual anatomical sites of eloquent cortex, neuroplasticity. Wang et al Chinese Neurosurgical Journal (2016) 2:12 plasticity and postoperative motor deficits,to find evidence for patient selection before surgical treatment
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