Brain arteriovenous malformations located in language area: Surgical outcomes and risk factors for postoperative language deficits

• Published in: World neurosurgery 2017-09, Vol.105, p.478-491
• Main Authors: Jiao, Yuming, MD, Lin, Fuxin, MD, Wu, Jun, MD, Li, Hao, Chen, Xin, Li, Zhicen, MD, Ma, Ji, MD, Cao, Yong, MD, Wang, Shuo, MD, Zhao, Jizong, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - physiopathology; Arteriovenous Fistula - surgery; Child; Diffusion tensor imaging; Female; Functional magnetic resonance imaging; Geschwind's area; Humans; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - physiopathology; Intracranial Arteriovenous Malformations - surgery; Language; Language area BAVMs; Language Disorders - diagnostic imaging; Language Disorders - physiopathology; Male; Microsurgery - adverse effects; Middle Aged; Neurosurgery; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Prospective Studies; Retrospective Studies; Risk factor; Risk Factors; Surgical outcome; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.159

Abstract Object Case selection for surgical treatment of language area brain arteriovenous malformations (L-BAVMs) remains difficult. This study aimed to determine the surgical outcomes and risk factors for postoperative language deficits (LD) in patients with L-BAVMs. Methods Patients with L-BAVMs who underwent microsurgical resection between September 2012 and June 2016 were reviewed. All patients had undergone preoperative functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). Both functional and angioarchitectural factors were analysed with respect to the postoperative LD. Functional factors included the eloquence involved, the side of BOLD signal activation and the white-matter fibres [anterior segment (AS), long segment (LS) and posterior segment (PS) of arcuate fasciculus (AF), and the inferior fronto-occipital fasciculus (IFOF)] involved. Results Sixty-nine patients with L-BAVMs were reviewed. Postoperative short- and long-term LD was found in 32 (46.4%) and 14 (20.3%) patients, respectively. Twelve of the 14 patients with Geschwind’s territory L-BAVMs (85.7%) suffered from short-term LD, compared with 10 (34.5%) in Wernicke’s and 10 (38.5%) in Broca’s area. LS involvement (P = 0.001) and larger nidus size (P = 0.017) were independent risk factors for the short-term LD. Meanwhile, nidus size (P = 0.007), preoperative LD (P = 0.008) and LS involvement (P = 0.028) were independent risk factors for long-term LD. Conclusions L-BAVMs located in Geschwind’s territory can cause a high incidence of LD. LS involvement and larger nidus size are risk factors for postoperative short- and long-term LD, and preoperative LD is a risk factor for postoperative, long-term LD.