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

Abstract

<jats:p> 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. </jats:p><jats:p> A 25-year-old man known for a right temporal grade V Spetzler-Martin classification arteriovenous malformation (AVM) presented with left progressive hemiparesis. </jats:p><jats:p> 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. </jats:p><jats:p> An improvement in the left hemiparesis and a reorganization of motor function were observed after endovascular treatment. </jats:p><jats:p> 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. </jats:p>

Arteriovenous malformation presenting as complex regional pain syndrome: illustrative case

“…There are numerous reports of a steal syndrome leading to motor deficits similar to those seen in our patient. 13,[22][23][24][25][26] However, directly conflicting with our patient's presentation, other reports have documented decreased sensation or even numbness to the body. 16 But this is not the first instance in which neurological pathologies result in opposing pain responses.…”

Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial

“…The interventional therapy group still contains patients awaiting initiation or completion of treatment at the discretion of the local investigator team. Later outcome status might show whether those whose modified Rankin score is 2 or higher will undergo brain functional reorganisation cited in some brain arteriovenous malformations 29 to the degrees known in focal brain infarcts. 30 The range of potential outcome events and potential changes in the clinical status gathered over the coming 5 years should provide important clinical insights into the best long-term management of patients diagnosed with an unruptured brain arteriovenous malformation.…”

Neuropsychological Performance after Brain Arteriovenous Malformations Treatment

“…Baker et al 13 reported a case of a patient with a right temporal AVM who showed improvement in IQ and visual memory after AVM excision. La Piana et al 18 reported a case of patients harboring right temporal S-M grade V AVM, presenting with progressive hemiparesis, who showed improvement in their neurologic status after partial embolization and motor cortex reorganization, which was documented on computed tomography perfusion scans. The fact that especially highgrade lesions scored lower in their composite score implies that a steal phenomenon caused by the AVM is in fact a wholebrain problem.…”