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

• Published in: World neurosurgery 2017
• Main Authors: Jiao, Yuming, MD, Lin, Fuxin, MD, Wu, Jun, MD, Li, Hao, MD, Chen, Xin, MD, Li, Zhicen, MD, Ma, Ji, MD, Cao, Yong, MD, Wang, Shuo, MD, Zhao, Jizong, MD
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2017.05.146

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.