Temporal Arteriovenous Malformation Research Articles

Incorporation of Brain Connectomics for Stereotactic Radiosurgery Treatment Planning.

Neurosurgeons have integrated neuroanatomy-based tractography to avoid critical structures during dose planning. However, they have yet to integrate more comprehensive connectome networks for radiosurgical planning. A young man presented with a Spetzler-Martin Grade 3 right temporal arteriovenous malformation. As proof of concept, we incorporated connectomic networks including default mode network, optic radiation and central executive network into the Gamma Knife radiosurgical treatment planning workflow. Connectome networks were created from T1 anatomic and diffusion-weighted images magnetic resonance images using Quicktome software. The resulting networks were voxel-encoded in the magnetic resonance images, imported into GammaPlan, and segmented by image thresholding. The GammaPlan Lightning optimizer was used to create radiosurgical plans with a dose of 20 Gy to the 50% isodose line delivered to the arteriovenous malformation nidus both with and without treating these networks as risk structures. When taking into account the connectome networks, a maximum dose restriction of 14 Gy was placed on each network during lightning dose planning. With default mode network, optic radiation, and central executive network as risk structures, the maximum dose and V 12Gy were reduced by 23.4% and 88.3%, 20% and 34.3%, and 29.8% and 63.2%, respectively. We were able to incorporate connectomes into radiosurgical dose planning approaches. This allowed for dose reductions to the networks while still achieving delivery of a therapeutic dose to the target volume.

Resting-state functional alterations in patients with brain arteriovenous malformations involving language areas.

Brain arteriovenous malformations (AVMs) may involve language areas but usually do not lead to aphasia. This study evaluated resting-state functional alterations and investigated the language reorganization mechanism in AVM patients. Thirty-nine patients with AVMs involving language areas and 32 age- and sex-matched healthy controls were prospectively enrolled. The AVM patients were categorized into three subgroups according to lesion location: the frontal (15 patients), temporal (14 patients), and parietal subgroups (10 patients). All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI), and the amplitude of low-frequency fluctuation (ALFF) approach was applied to analyze rs-fMRI data. Language abilities were normal in all participants based on the Western Aphasia Battery. Compared with those of healthy subjects, ALFF values significantly increased (FDR corrected p < .01) in the anterior part of the right putamen in the frontal AVM subgroup, in the posterior part of the right inferior and middle temporal gyrus in the temporal AVM subgroup, and in the inferior lateral part of the left cerebellar hemisphere (lobule VIII) and the right inferior parietal lobule in the parietal AVM subgroup. Functional annotation using Neurosynth indicated that the ALFF t-map was only significantly positively associated with the language-related domain (FDR corrected p < .01). In patients with AVMs involving the language cortex, language network reorganization occurs to maintain normal language abilities. The brain areas recruited into the reorganized language network were located in the right cerebral and left cerebellar hemispheres, both of which are nondominant hemispheres. Differences in lesion location led to distinct reorganization patterns.

You Take the Low Road: Differential Outcomes After Tangential and Transcortical Approaches to Medial Temporal Brain Arteriovenous Malformations

Microsurgical resection of medial temporal brain arteriovenous malformations (AVMs) is typically conducted through 2 approaches: the orbitozygomatic-tangential and subtemporal-transcortical. Relative indications and outcomes for these techniques have not been formally compared. The cerebrovascular database of a quaternary center was reviewed for patients with medial temporal AVMs treated between January 1, 1997, and July 31, 2021. Demographic characteristics, lesion characteristics, surgical approaches, and outcomes were retrospectively analyzed and compared. Postoperative outcome testing was performed using the Montreal Cognitive Assessment and Global Quality of Life Scale. Fifty-nine patients were assessed. Mean (standard deviation) age was 31 (18) years; 30 (51%) patients were male. Of the AVMs, 29 (49%) were left-sided and 30 (51%) were right-sided. The tangential approach was selected in 20 (34%) cases, whereas the transcortical technique was preferred in 39 (66%). Improved modified Rankin Scale status was significantly associated with the tangential resection technique both in the early postoperative period (P= 0.02) and at last follow-up (P= 0.01). Differences between the tangential and transcortical approaches were not significant with respect to new postoperative deficits (5/20 [25%] vs. 12/39 [31%], P= 0.87) or the presence of residual AVM on follow-up angiography (1/20 [6%] vs. 5/39 [14%], P= 0.65). The orbitozygomatic-tangential strategy was associated with favorable functional and quality-of-life outcomes after medial temporal AVM resection. These benefits are likely to be attributable to minimization of temporal retraction, avoidance of brain transgression, and avoidance of traction on the vein of Labbé, rendering the orbitozygomatic-tangential approach the preferred option for cases that are anatomically amenable to either strategy.

Case report of a large, right, temporal arteriovenous malformation in the brain manifested by a progressive visual field defect

AbstractPurpose: Emphasizing the importance of regular vision screening with visual fields and rapid MRI investigations where a field defect is unexplained. A 44 yo patient with a history of headache and incipient development of hemianopia gradually noticed bumping into things on the left‐hand side. In the last 6 months she also described 2 clear episodes of 5 min absence seizures, when she was staring into space. She has a history of iron deficiency being treated. Visual acuity was 6/6 corrected, right eye and 6/6‐2, corrected left eye. Normal pupillary reflexes. Visual fields showed gross left homonymous hemianopia. Optic discs showed no palor or cupping.Methods: Brain MRI showed a complex right temporal arteriovenous malformation (AVM) predominately supplied from the middle cerebral artery. There is a variceal dilation. There was some gliosis in the right temporal lobe suggesting previous bleed.Results: Urgent neurosurgeon assessment and catheter angiogram found a complex AVM which will likely be treated with gamma knife or embolization given patient age and previous evidence of bleed.Conclusions: This interesting case illustrates the importance of urgent imaging when faced with an abnormal visual field defect with no other underlying pathology.

Prophylactic Awake Peripheral VA ECMO TAVI Is Safe and Effective: A Case Series and Patient Management Algorithm

Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%–11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge.Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1, 2, 3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.

Topical Drug Application to Treat Infective Endocarditis – Preclinical Investigation of Novel Therapeutic Options for an Unmet Medical Need

Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%–11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge.Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1, 2, 3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.

Interest of awake surgery for ruptured cerebral arteriovenous malformations close to speech areas – Surgical note

BackgroundCerebral arteriovenous malformations (AVMs) are rare, with incidence of 1.12–1.42 cases per 100,000 person-years (Ozpinar et al., 2017). Few studies report applications of awake surgery. The goal of this report was to assess the interest of awake surgery in complete resection of cortical AVMs located close to eloquent speech areas, enabling detection of real functional cortical reorganization due to the AVM and parenchymal hematoma. Case reportA 38-year-old right-handed patient was admitted to the University Hospital of Besançon for dysphasia due to a ruptured left temporal arteriovenous malformation. The patient underwent asleep-awake-asleep surgery. Intraoperative cortical mapping revealed the presence of functional language areas in uncommon locations compared to known neuro-functional anatomy. DiscussionIn this patient, speech areas were redistributed, probably due to neuroplasticity after cerebral hemorrhage, leading to a new cortical architecture, which would have been unrecognized based on preoperative radiological imaging alone. ConclusionWe report the interest of awake surgery to achieve complete safe resection of ruptured AVMs located close to eloquent speech areas, using intraoperative cortical mapping.

VENTAJAS DE LA VIDEOANGIOGRAFÍA INTRAOPERATORIA CON FLUORESCEÍNA INTEGRADA AL MICROSCOPIO EN PATOLOGÍA CEREBROVASCULAR. EXPERIENCIA INICIAL EN EL HOSPITAL NACIONAL DOS DE MAYO

Introduction: Fluorescein sodium (FNa) is a fluorescent substance used to evaluate cerebral blood flow. We present our first cases of vascular microsurgery using microscope-integrated intraoperative fluorescein video angiography. We review the practical applications and benefits of this technique in vascular microsurgery. Clinical cases: A 63-year-old woman, Glasgow: 9 on admission, with subarachnoid hemorrhage (SAH) Fisher IV. A ruptured anterior communicating aneurysm was diagnosed. After stabilization in the ICU, she underwent surgery, undergoing microsurgical clipping guided by intraoperative videoangiography. The postoperative evolution was favorable. A 33-year-old man with a history of epilepsy on carbamazepine treatment. After suspension and irregular treatment 2 years ago, seizures reappear. An angiography and magnetic resonance imaging were performed, and he was diagnosed with a left posterior temporal arteriovenous malformation (AVM) close to Wernicke's area, for which he underwent surgery using tractography and videoangiography in real-time integrated into Neuronavigation. In both cases, the benefits of using the integrated microscope were observed thanks to the vascular anatomical assessment in real-time with fluorescein. Conclusion: Videoangiography with FNa allows examining afferent and efferent vessels during surgery for arteriovenous malformations, checking the persistence of flow in a microvascular anastomosis, and evaluating flow during clipping of an aneurysm. It has the advantages of being able to be repeated during surgery, allowing surrounding anatomical visualization, as well as allowing any surgical correction in real-time. Keywords: Fluorescein Angiography, Microsurgery, Aneurism, Arteriovenous Malformations (Source: MeSH NLM)

Intraparotid Superficial Temporal Artery Arteriovenous Malformation Causing Persistent Pulsatile Tinnitus.

This article discusses the diagnosis, imaging workup, and management of a rare cause of pulsatile tinnitus: intraparotid arteriovenous malformation. A single patient with a superficial temporal arteriovenous malformation diagnosed by carotid duplex causing pulsatile tinnitus that failed initial surgical management. Repeat imaging failed to identify a cause for the persistent tinnitus. Reoperation with a parotid approach based on physical exam findings. Removal of a more proximal arteriovenous malformation in the parotid gland resulted in long-term resolution of the patient's pulsatile tinnitus. Physical examination is essential in the workup and management of pulsatile tinnitus. Imaging is a useful adjunct in the diagnosis of pulsatile tinnitus but should not be solely relied upon.

Seizure Presentation in Patients With Brain Arteriovenous Malformations Treated With Stereotactic Radiosurgery: A Multicenter Study

Abstract INTRODUCTION Seizures are the second most common clinical presentation in patients with brain arteriovenous malformations (AVMs), and they are the most common presentation of unruptured AVMs. The aim of this multicenter, retrospective cohort study was to identify predictors of seizure presentation in AVM patients treated with stereotactic radiosurgery (SRS). METHODS We performed a retrospective review of AVM patients treated with SRS at 8 participating International Radiosurgery Research Foundation sites. Patient and AVM characteristics were compared between those with versus without a seizure presentation in univariable and multivariable models. Subgroup analysis of patients with cortical AVMs was performed. RESULTS The study cohort comprised 2333 AVM patients, including 419 (18%) with and 1914 (82%) without a seizure presentation. Prior AVM resection (OR = 7.65, P = .001), lack of prior AVM hemorrhage (OR = 0.004, P &lt; .001), cortical AVM location (OR = 1559.42, P &lt; .001), lower Spetzler-Martin (SM) grade (OR = 0.51, P = .007), and higher Virginia Radiosurgery AVM Score (VRAS; OR = 1.46, P = .008) were independent predictors of seizure presentation. The rate of seizure presentation in patients with cortical AVMs was 27%. Prior AVM resection (OR = 8.36, P &lt; .001), lack of prior AVM hemorrhage (OR = 0.004, P &lt; .001), and temporal AVM location (OR = 4.15, P &lt; .001) were independent predictors of seizure presentation for cortical AVMs. CONCLUSION We identified multiple factors associated with seizure presentation in AVM patients selected to undergo SRS. Prior AVM resection, cortical AVM location, and lack of prior AVM hemorrhage were the strongest predictors of pre-SRS seizures. SM grade and VRAS may have a role in seizure risk stratification. Among cortical AVMs, temporal lobe localization was predictive of seizure presentation.

Seizure Presentation in Patients with Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery: A Multicenter Study

Seizures are the second most common clinical presentation in patients with brain arteriovenous malformations (AVMs) and the most common presentation of unruptured AVMs. The aim of the present multicenter, retrospective cohort study was to identify the predictors of seizure presentation in patients with AVM who had undergone stereotactic radiosurgery (SRS). We performed a retrospective review of patients with AVM who had been treated with SRS at 8 participating International Radiosurgery Research Foundation sites. The patient and AVM characteristics were compared between those with and without seizure presentation in univariable and multivariable models. A subgroup analysis of patients with cortical AVMs was performed. The study cohort included 2333 patients with AVM, including 419 (18%) with and 1914 (82%) without a seizure presentation. Previous AVM resection (odds ratio [OR], 7.65; P= 0.001), a lack of previous AVM hemorrhage (OR, 0.004; P < 0.001), a cortical AVM location (OR, 1559.42; P < 0.001), a lower Spetzler-Martin grade (OR, 0.51; P= 0.007), and a higher Virginia radiosurgery AVM score (OR, 1.46; P= 0.008) were independent predictors of seizure presentation. The rate of seizure presentation in patients with cortical AVMs was 27%. Previous AVM resection (OR, 8.36; P < 0.001), a lack of previous AVM hemorrhage (OR, 0.004; P < 0.001), and temporal AVM location (OR, 4.15; P<0.001) were independent predictors of seizure presentation for cortical AVMs. We identified multiple factors associated with seizure presentation in patients with AVM to undergo SRS. Previous AVM resection, a cortical AVM location, and a lack of previous AVM hemorrhage were the strongest predictors of pre-SRS seizures. The Spetzler-Martin grade and Virginia radiosurgery AVM score might have a role in seizure risk stratification. For cortical AVMs, a temporal lobe location was predictive of seizure presentation.

Characteristics and Long-Term Outcome of 127 Children With Cerebral Arteriovenous Malformations

Population-based long-term data on pediatric patients with cerebral arteriovenous malformations (AVMs) are limited. To clarify the characteristics and long-term outcome of pediatric patients with AVM. A retrospective analysis was performed on 805 consecutive brain AVM patients admitted to a single center between 1942 and 2014. The patients were defined as children if they were under 18 yr at admission. Children were compared to an adult cohort. Changing patterns of presentation were also analyzed by decades of admission. The patients comprised 127 children with a mean age of 12 yr. The mean follow-up time was 21 yr (range 0-62). Children presented more often with intracerebral hemorrhage (ICH) but less often with epilepsy than adults. Basal ganglia, cerebellar, and posterior paracallosal AVMs were more common in pediatric than in adult patients. Frontal and temporal AVMs, in contrast, were more common in adult than in pediatric patients. As the number of incidentally and epilepsy-diagnosed AVMs increased, ICH rates dropped in both cohorts. In total, 22 (82%) pediatric and 108 (39%) adult deaths were assessed as AVM related. After multivariate analysis, small AVM size and surgical treatment correlated with a favorable long-term outcome. Hemorrhagic presentation was more common in children than in adults. This was also reflected as lower prevalence of epileptic presentation in the pediatric cohort. Lobar and cortical AVM locations were less frequent, whereas deep and cerebellar AVMs were more common in children. Hemorrhagic presentation correlated negatively with incidentally and epilepsy-diagnosed AVMs. In children, AVM was a major cause of death, but in adults, other factors contributed more commonly to mortality.

Intractable epilepsy associated with angiographic obliteration of a medial temporal arteriovenous malformation following stereotactic radiosurgery

Abstract We present a case with recurrence of intractable complex partial epilepsy, despite angiographic obliteration of a cerebral arteriovenous malformation in the left medial temporal lobe following gamma knife radiosurgery. Preoperative memory function was normal, with no evidence of hippocampal atrophy by magnetic resonance imaging. Intraoperative electrocorticography demonstrated two independent foci of paroxysmal activity in the lateral and medial temporal lobes. As preoperative magnetic resonance imaging demonstrated subcortical hyperintensity, the lateral temporal lobe was resected. Histologically, there was evidence of subcortical myelin pallor, likely resulting from ischemic damage associated with hemodynamic changes following radiosurgery. As there was a decrease in the frequency of paroxysmal discharges in the hippocampus following arteriovenous malformation nidus removal, the hippocampus was preserved. Histological examination of the nidus revealed that some of the vessels had patent lumina, while ischemia affecting the neighboring hippocampus was considered to show improvement. A good seizure outcome was obtained. In summary, perioperative multimodal examinations, including intraoperative electrocorticography, revealed various epileptogenic mechanisms, probably related to myelin pallor in the lateral temporal lobe and focal ischemia secondary to patent AVM in the medial temporal lobe, of this patient.

Delayed Venous Drainage in Ruptured Arteriovenous Malformations Based on Quantitative Color-Coded Digital Subtraction Angiography

Clinically applicable hemodynamic risk factors to predict arteriovenous malformation (AVM) rupture are missing in the literature. The aim of this study was to use catheter angiography to identify hemodynamic parameters in ruptured and unruptured AVMs. Patients with frontal and temporal AVMs and Siemens syngo iFlow color-coding angiography were included in this study (n= 71). Clinical and radiologic data (age, sex, Spetzler-Martin [SM] and supplemented SM grade, and rupture status), and hemodynamic features (contrast mean transit time [MTT] of feeding arteries, draining veins, AVM nidus, and the cerebral circulation time [CCT]) were analyzed. Univariable analysis was performed to compare findings between ruptured and unruptured AVMs. In total, 35 ruptured and 36 unruptured AVMs were analyzed. Clinical characteristics and AVM grades were comparable between ruptured and unruptured AVMs. Ipsilateral CCT (5.2 vs. 4.0 seconds; P= 0.035), MTT between Tmax of the ipsilateral internal carotid artery and Tmax of sinus entry of the draining vein (3.2 vs. 2.0 seconds; P < 0.001), and MTT between Tmax at the start of venous outflow and Tmax of sinus entry (1.6 vs. 0.7 seconds; P<0.0001) were significantly longer in ruptured compared with unruptured AVMs. MTTs of nidus, between the internal carotid and feeding arteries, of the venous sinus passage as well as contralateral CCT and controlled ipsilateral CCT were comparable between both groups. Ruptured AVMs have significantly prolonged venous drainage times compared with unruptured AVMs; this suggests restricted AVM drainage and increased blood pressure within the AVM nidus. Prospective studies are needed to determine the predictive power of these measurements.

Unruptured Epileptogenic Brain Arteriovenous Malformations.

To determine whether specific clinical and radiographic factors predispose arteriovenous malformations (AVMs) presenting with seizure and to predict the seizure risk for individual AVM patients. Clinical features and cerebral angiograms of consecutive 45 unruptured AVM patients who were diagnosed in our center in a 2-year period were reviewed. Patient data (analysis cohort) was used to determine risk factors for seizure and to construct epileptogenic AVM groups. These risk groups were tested with the second half of the patient data (test cohort). Among 45 unruptured AVMs (47.9%), initial seizures occurred in 20 unruptured AVMs (44.4%). Two of these 20 patients had a bleed in 117 patient-years for an annual bleed rate of 1.7%. There was no significant difference in hemorrhagic risk between epileptogenic AVM and asymptomatic AVM (P=0.918). Multivariate analysis revealed 2 factors associated with seizure: frontal and temporal AVM locations (P < 0.001) and a compact AVM morphology (P=0.003). Analysis of a group of unruptured AVMs demonstrated that epileptogenic AVMs have an annual hemorrhage risk similar to that of the asymptomatic AVMs. Frontal and temporal AVM locations and a compact AVM morphology were significantly associated with epileptogenic AVMs.

Clipping of Lateral Posterior Choroidal In-traventricular Aneurysm Related to Ruptured Temporal Arteriovenous Malformation: Case Report

Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneurysms in the choroidal arteries. Those related to an AVM are even rarer and only two cases have been previously reported. Aim: To discuss the unusual location of this aneurysm, its relationship to other conditions and the type of treatment. Case Presentation: We present the case of a patient with a non-ruptured intraventricular aneurysm of lateral posterior choroidal artery related to a ruptured right temporal arteriovenous malformation, who was successfully treated by clipping immediately, after resection of the malformation. Conclusion: Intraventricular choroidal artery aneurysm is a rare pathology. Its deep location makes the treatment challenging but mandatory due to the high probability of bleeding, especially those flow-related to an arteriovenous malformation.

The Effect of Age, Sex, and Lesion Location on Initial Presentation in Patients with Brain Arteriovenous Malformations

ObjectiveTo identify whether age, sex, and lesion location are associated with initial presentation in patients with brain arteriovenous malformations (AVMs). MethodsCollected data of 3299 consecutive patients with AVM treated at Beijing Tiantan Hosptial from January 1980 to January 2015 were analyzed. The variables assessed were age at diagnosis, sex, AVM location, and mode of initial presentation. ResultsInitial presentation was AVM hemorrhage in 57.9%, seizure in 20.9%, chronic headache in 14.9%, focal neurologic deficit in 5.2%, and incidental in 1.2%. Younger age and female sex were associated with initial hemorrhage (all P < 0.05). Hemorrhage was more likely to occur in patients with AVMs in the basal ganglia, the corpus callosum, the ventricles, the cerebellum, and the brainstem (all P < 0.05). Male sex was associated with initial seizure (P < 0.05). Initial seizure was more likely to occur in patients with AVMs in the frontal, temporal, parietal, frontotemporal, and frontoparietal lobe (all P < 0.05). Compared with frontal AVMs, temporal AVMs were more likely to present with hemorrhage (P < 0.05) and less likely to present with seizure (P < 0.05). AVMs involving the occipital lobe were more likely to present with chronic headaches (P < 0.05). ConclusionsInitial AVM presentation varied with patient age, sex, and AVM locations. Younger age, female sex, and deep and infratentorial locations may be associated with initial hemorrhage. Male sex and frontal, temporal, and parietal AVM locations may be predictors of initial seizure. Chronic headache was more likely to occur in patients with AVMs involving the occipital lobe.

Mouse Models of Cerebral Arteriovenous Malformation.

Arteriovenous (AV) malformation (AVM) is a vascular anomaly capable of both hemorrhagic and ischemic insults, leading to seizures, headaches, stroke, and even death.1 BAVM prevalence is estimated at 0.05%,2 often occurring in young people between 20 and 40 years of age.3 BAVMs account for 50% of hemorrhagic stroke in children4 and 1% to 2% of all strokes in the population.5 Brain AVMs (BAVMs) can cause life-threatening intracerebral hemorrhage (Figure 1).6 Fifty percent of patients are first diagnosed on intracerebral hemorrhage,1 with 1% and 5% annual hemorrhage rate for previously unruptured and ruptured AVMs, respectively.7,8 After BAVM rupture, reported mortality rates range from to 15% to 29%,7 and long-term morbidity rates range from 16% to 56%.1,9 Thus, BAVM is defined by vascular features and accompanying neurological deficits.1 Figure 1. Features of human brain arteriovenous malformation (AVM). A , An AVM is visualized on the lateral temporal surface of a human brain. 5, 6 are landmarks placed by surgeon; 40 shows Broca's area; 48 shows Wernicke's area. B , Left internal carotid artery (ICA) angiography (lateral view) reveals a left lateral temporal AVM with a large feeding artery and draining vein. C , Cartoon of this subtype (lateral view), indicating feeding arteries and draining veins. ATA indicates anterior temporal artery. Reprinted from Lawton6 with permission of the publisher. Copyright © 2014, Thieme Medical Publishers. AVM is characterized by high-flow AV connections that shunt blood directly from arteries to veins, displacing intervening capillaries with a nidus of enlarged and tortuous vessels. BAVM clinical characteristics include (1) AV shunting, the presence of direct connections between arteries and veins, displacing intervening capillaries; (2) abnormally high blood flow through the feeding artery, AV …

A-48 * Cognitive Correlates of Bilateral Arteriovenous Malformations: A Case Report

Objective: Bilateral arteriovenous malformations (AVMs) are clinically rare except in hereditary autosomal disease. There is conflicting evidence on the incidence and severity of cognitive symptoms in non-hemorrhagic AVMs. The relationship between a patient's cognitive profile and the size and location of multiple AVMs was explored in this case study. Method: A 20-year-old white female with new onset seizures during her second trimester of pregnancy was diagnosed with non-familial, bilateral, temporal AVMs. Prior history included depression, headaches, and attentional problems. Following successful delivery of child, the patient completed a clinical interview and a standard comprehensive battery of tests assessing learning, memory, language, executive, spatial, and fine motor functioning. Presenting complaints included memory, concentration, and word-finding difficulties in the context of headaches. Imaging documented an AVM in the left temporal, lateral, cortical region at the superior and middle temporal gyri measuring 3.5cm, and a second AVM in the right hippocampus measuring 1.5 cm. Results: Testing documented mild working memory (CVLT, Trial 1 = 5/16), fluency (phonemic T = 39), and naming difficulties (BNT T = 38), as well as right-sided weakness (Grip T = 33). Spatial, attention, and visual memory skills were intact (T ≥ 43). Conclusion(s): Lateralizing findings were consistent with the size and location of the AVMs. Results of the present study suggest that non-ruptured AVM may result in cognitive deficits as a function of not just to location, but of AVM size. Neuropsychological data was used to plan initial surgical intervention around the left sided AVM, thus. Thus, neuropsychological examination may aid in surgical treatment planning.

Brain Reorganization after Endovascular Treatment in a Patient with a Large Arteriovenous Malformation: The Role of Diagnostic and Functional Neuroimaging Techniques

We describe a case of brain cortical reorganization after embolization of a large right temporal arteriovenous malformation. A comprehensive imaging protocol, including functional magnetic resonance imaging (fMRI), cortical thickness analysis and 320-row computed tomography (CT) perfusion was used to provide information on brain plasticity and potential steal phenomenon. A 25-year-old man known for a right temporal grade V Spetzler-Martin classification arteriovenous malformation (AVM) presented with left progressive hemiparesis. He underwent functional 3T magnetic resonance imaging (fMRI), cortical thickness analysis, and CT perfusion (CT 320 row, Aquilion ONE, Toshiba, Tokyo, Japan) before and after endovascular treatment. The results were compared to look for modifications in brain perfusion and organization. An improvement in the left hemiparesis and a reorganization of motor function were observed after endovascular treatment. Modifications in the angioarchitecture and perfusion of an extensive AVM may be accompanied by a functional and structural reorganization of the brain. The location in the so-called eloquent regions may not be sufficient to explain the wide spectrum of symptoms that these patients can present. A more comprehensive approach considering a global involvement of the brain in patients with large AVMs is suggested to achieve the best treatment strategy and to stage treatment in incurable AVMs.