Abstract
Objective: The goal of this study was to systematically review functional mapping and reorganization that takes place in the setting of arteriovenous malformations (AVMs) and its potential impact on grading and surgical decision making.Methods: A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. Studies assessing brain mapping and functional reorganization in AVMs were included.Results: Of the total 84 articles identified in the original literature search, 12 studies were ultimately selected. This includes studies evaluating the impact of cortical reorganization on patient outcomes and factors impacting and triggering cortical reorganization in AVM.Conclusion: These studies demonstrate the utility of preoperative brain mapping and acknowledgment of functional reorganization in the setting of AVMs. While these findings led to alterations in Spetzler–Martin grading and subsequent surgical decision making, it remains unclear the clinical utility of this information when assessing patient outcomes. While promising, more research is required before recommendations can be made regarding functional brain mapping and cortical reorganization with respect to AVM surgery involving eloquent brain tissue.
Highlights
Functional reorganization refers to a change in the size or location of task-specific neural processing centers
The first mention of functional cerebral imaging being used in the setting of arteriovenous malformations (AVMs) was more than two decades ago, where it was determined that positron emission tomography (PET) imaging was a reliable method in evaluating the relationship of motor, language, and visual cortex centers with AVMs [6]; given the lack of mass effect and cerebral swelling, AVMs were determined to be good candidates for functional imaging, as there is minimal brain distortion confounding imaging interpretation when compared with other lesion types [6,7,8], the effects of cerebrovascular reactivity and presence of hemosiderin inherent to AVMs make non-blood flow-based techniques important [9]
The following three search queries were performed without language restriction to identify all relevant titles and abstracts in the NCBI/NLM PubMed and Medline databases: AND, AND, AND
Summary
Functional reorganization refers to a change in the size or location of task-specific neural processing centers. Identifying cortical reorganization has been made possible by the advent of brain mapping techniques, with evidence of reorganization taking place in neurodegenerative disease, stroke, and brain tumors [1] This includes functional magnetic resonance imaging (fMRI), positron emission tomography (PET), magnetoencephalography (MEG)/magnetic source imaging (MSI), and transcranial magnetic stimulation (TMS), which have enabled mapping of cortical architecture in real time. These modalities have proved useful in surgical planning and resection of lesions. AVMs are considered congenital lesions that are likely present prior to the maturation of eloquent areas, suggesting that patients have an increased susceptibility to functional displacement given the inherent plasticity of the cortex during growth and development [3, 4]. The first mention of functional cerebral imaging being used in the setting of AVMs was more than two decades ago, where it was determined that PET imaging was a reliable method in evaluating the relationship of motor, language, and visual cortex centers with AVMs [6]; given the lack of mass effect and cerebral swelling, AVMs were determined to be good candidates for functional imaging, as there is minimal brain distortion confounding imaging interpretation when compared with other lesion types [6,7,8], the effects of cerebrovascular reactivity and presence of hemosiderin inherent to AVMs make non-blood flow-based techniques important [9]
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