Preoperative Versus Postoperative Neuropsychological Sequelae of Arteriovenous Malformations

Abstract

In a cohort of 14 patients suffering from cerebral arteriovenous malformations (AVM), neuropsychological functioning was examined before and after AVM resection. Improvements after surgery were assumed to be due to enhanced neurocognitive functions associated with the hemisphere ipsilateral to the AVM, and to a lesser extent, with the contralateral hemisphere. Before surgical intervention, the performances of AVM patients were deficient relative to matched normals. Postoperatively, neuropsychological gains were observed particularly in the areas of learning, memory, and higher integrative thought, not only for ipsilateral, but also for contralateral functioning. Contralateral and ipsilateral improvement is consistent with the premise that cerebrovascular steal is lessened; thus, neurosurgical intervention to eliminate arteriovenous shunts was found to result in overall neurobehavioral gains.

The Impact of Arteriovenous Malformation Radiosurgery on the Brain: From Morphology and Perfusion to Neurocognition

“…The AVM is eliminated by gradually evolving radiation effects [3] . Compared to the patient cohort of conventional surgery, as reported by Mahalick et al [12] , the postoperative cognitive condition of patients receiving radiosurgery should be different. In a long-term postradiosurgical follow-up, Riva et al [13] found normal neurobehavior of 8 AVM patients an average of 6 years after radiosurgery.…”

“…On the contrary, Blonder et al [11] examined 10 AVM patients with neuropsychological tests and found a slightly impaired function compared to normal controls. Mahalick et al [12] found neuropsychological impairment in all of their 24 patients prior to surgical treatment and reported that roughly 50% had improved after surgery. In radiosurgery no real 'open surgery' is performed.…”

Can arterial spin labeling detect white matter perfusion signal?

“…This shows the clinical potential of ASL for therapeutic evaluation of WM perfusion deficits, again showing the clinical potential of ASL. The occurrence of perfusion deficits in tissue near an AVM has been described in the literature and may be related to the so-called steal phenomenon: a high flow volume shunted through an AVM fistula may induce a decrease in cerebral perfusion pressure in surrounding brain tissue (26). However, as evidenced by DSC-MRI, the hypointense area on the ASL scans is most probably caused by an increased transit time rather than hypoperfusion.…”

Neuropsychological Features of Lesion-related Epilepsy in Adults: An Overview

“…Cognitive deficits in patients with AVMs may be present in 60 to 80% of cases (Gomez-Tortosa et al 1995;Mahalick et al 1993). The majority of the literature describes patients with ruptured AVMs, many of whom present with seizures, however, studies investigating the specific effects of seizures on neuropsychological profile in these patients are generally not available.…”