Description of a tailored functional approach in the surgical treatment of arteriovenous malformations in eloquent areas

Abstract

BACKGROUND: Brain arteriovenous malformations (AVMs) are congenital abnormalities of cerebral blood vessels due to inadequate development of capillary network and characterized by a collection of abnormal dilated and entangled vessels denominated nidus fed by arteries and drained by veins without capillary involvement. AVMs have a low prevalence in the general population but are an important cause of spontaneous intracranial bleeding in young adults. The treatment of AVMs in eloquent areas is controversial due to the high risk of post-surgical neurological deficits, and there is a debate between conservative management and invasive treatments (microsurgery, embolization or radiosurgery). With a tailored pre- and intraoperative functional study, good results can be obtained, reducing the risk of post-operative neurological deficits to preserve an adequate neurological function. HYPOTHESIS AND OBJECTIVE: We hypothesize that a tailored functional approach for the management and treatment of AVMs in eloquent supratentorial areas (individualized pre- and intraoperative functional assessment) allows complete surgical resection in most cases (> 70 %) and a cure rate > 90% (reached in combination with embolization and/or radiosurgery), while obtaining a good clinical result (mRS ≤ 2) and a correct preservation of neurological function (< 25% patients with neurological deficit) at 6 months. The aim is to describe the outcomes of the Bellvitge University Hospital Neurosurgery Department functional protocol for the treatment of eloquent sited AVMs, and to examine the usefulness of functional assessment (pre- and intraoperative) and multidisciplinary approach for these particular AVMs