Awake craniotomy for excision of arteriovenous malformations? A qualitative comparison study with stereotactic radiosurgery

• Published in: Journal of clinical neuroscience 2018-05, Vol.51, p.52-56
• Main Authors: Chan, David Yuen Chung, Chan, Danny Tat Ming, Zhu, Cannon Xian Lun, Kan, Patricia Kwok Yee, Ng, Amelia Yikjin, Hsieh, Yi-Pin Sonia, Abrigo, Jill, Poon, Wai Sang, Wong, George Kwok Chu
• Format: Article
• Language: English
• Subjects: Arteriovenous malformation; Awake craniotomy; Awake mapping; Eloquent; Excision
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2018.02.019

•Awake AVM excision can achieve complete obliteration in 83.3% of the cases in this study.•Complete obliteration rate of AVM with awake excision was higher than the corresponding SRS obliteration rate in this study.•Awake mapping in selected patients with AVMs at the eloquent areas can facilitate resection with preservation of functions. Treatment of arteriovenous malformations (AVM) located at the eloquent area has been a challenge. Awake brain mapping allows identification of a non-eloquent gyrus for intervention and can potentially facilitate resection with preservation of functions. An alternative treatment option is stereotactic radiosurgery (SRS). The objective of this study was to perform a qualitative comparison of the treatment outcome of awake AVM excision versus SRS. We conducted a 13-year retrospective review of AVM excision under awake craniotomy performed at Prince of Wales Hospital, Hong Kong, from 2003 to 2016. Patients’ presentation, Spetzler-Martin (SM) grading, rate of obliteration and complication were reviewed and analyzed with the modified radiosurgery-based AVM score (RS score). Six patients had excision of AVM under awake mapping during this period of time. Two were SM Grade II and four were SM Grade III. Five located at the peri-rolandic region while one at the temporal language area. None had failed mapping. Five out of six achieved complete obliteration (83.3%). Qualitative comparative analysis had revealed better treatment outcome with awake AVM excision as compared to SRS with the obliteration rate of 100% versus 96% for RS score ≤1.00, 100% versus 78% for RS score 1.01–1.50, and 66% versus 50% for RS score >2.00 respectively. In conclusion, awake mapping and excision of AVMs at the eloquent area is feasible. Qualitative comparative analysis had revealed higher obliteration rate with awake AVM excision as compared to SRS.