Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Lin, Fuxin; Zhao, Bing; Wu, Jun; Wang, Lijun; Zhou, Jin; Cao, Yong; Wang, Shuo

doi:10.3171/2015.6.jns15969

Cited by 22 publications

(25 citation statements)

References 34 publications

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“…Axial time-of-flight (TOF) MR angiography was performed using a 3D TOF gradient-echo acquisition sequence (TR 22 msec, TE 3.86 msec, slice thickness 1 mm, slices 36 × 4, FOV 220 × 220 mm 2 , flip angle 120°, matrix 512 × 512). 17…”

Section: Neuroimagingmentioning

confidence: 99%

“…8,16 In previous studies, we demonstrated that the LED measured using fMRI and DTI data was a significant predictor of surgical outcomes for BAVM located in eloquent motor area or the occipital lobe. 17,23 However, as far as we know, there are still no prediction models for surgical outcomes of BAVM that include the LED. Whether adding LED information to a previous grading system can be used to build a supplementary grading system that would better predict neurological outcome remains unclear.…”

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confidence: 99%

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A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations

Jiao

Lin

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Case selection for the surgical treatment of brain arteriovenous malformations (BAVMs) remains challenging. This study aimed to construct a predictive grading system combining lesion-to-eloquence distance (LED) for selecting patients with BAVMs for surgery. METHODS Between September 2012 and September 2015, the authors retrospectively studied 201 consecutive patients with BAVMs. All patients had undergone preoperative functional MRI and diffusion tensor imaging (DTI), followed by resection. Both angioarchitectural factors and LED were analyzed with respect to the change between preoperative and final postoperative modified Rankin Scale (mRS) scores. LED refers to the distance between the lesion and the nearest eloquent area (eloquent cortex or eloquent fiber tracts) measured on preoperative fMRI and DTI. Based on logistic regression analysis, the authors constructed 3 new grading systems. The HDVL grading system includes the independent predictors of mRS change (hemorrhagic presentation, diffuseness, deep venous drainage, and LED). Full Score combines the variables in the Spetzler-Martin (S-M) grading system (nidus size, eloquence of adjacent brain, and venous drainage) and the HDVL. For the third grading system, the fS-M grading system, the authors added information regarding eloquent fiber tracts to the S-M grading system. The area under the receiver operating characteristic (ROC) curves was compared with those of the S-M grading system and the supplementary S-M grading system of Lawton et al. RESULTS LED was significantly correlated with a change in mRS score (p < 0.001). An LED of 4.95 mm was the cutoff point for the worsened mRS score. Hemorrhagic presentation, diffuseness, deep venous drainage, and LED were independent predictors of a change in mRS score. Predictive accuracy was highest for the HDVL grading system (area under the ROC curve 0.82), followed by the Full Score grading system (0.80), the fS-M grading system (0.79), the supplementary S-M grading system (0.76), and least for the S-M grading system (0.71). Predictive accuracy of the HDVL grading system was significantly better than that of the Spetzler-Martin grade (p = 0.040). CONCLUSIONS LED was a significant predictor for the preoperative risk evaluation for surgery. The HDVL system was a good predictor of neurological outcomes after BAVM surgery. Adding the consideration of the involvement of eloquent fiber tracts to preoperative evaluation can effectively improve its predictive accuracy.

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Section: Neuroimagingmentioning

confidence: 99%

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confidence: 99%

A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations

Jiao

Lin

et al. 2018

Journal of Neurosurgery

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“…In addition, the eloquence includes functional cortex, deep brain, and brain stem, while some important subcortical tracts are outside the scope of the definition. Compared with the cortex, tract injury seems to result in a more long-term neurological deficit, where the functional reorganization might be slow [24]. …”

Section: Discussionmentioning

confidence: 99%

Morbidity after Hemorrhage in Children with Untreated Brain Arteriovenous Malformation

Ma¹,

Kim²,

Chen

et al. 2017

Cerebrovasc Dis

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Background: Children with untreated brain arteriovenous malformations (bAVM) are at risk of encountering life-threatening hemorrhage very early in their lives. The primary aim of invasive treatment is to reduce unfavorable outcome associated with a bAVM rupture. A better understanding of the morbidity of bAVM hemorrhage might be helpful for weighing the risks of untreated bAVM and invasive treatment. Our aim was to assess the clinical outcome after bAVM rupture and identify features to predict severe hemorrhage in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and December 2014. Clinical outcome after hemorrhagic presentation and subsequent hemorrhage was evaluated using the modified Rankin Scale (mRS) for children. The association of demographic characteristics and bAVM morphology with severe hemorrhage (mRS >3 or requiring emergency hematoma evacuation) was studied using univariate and multivariable regression analyses. A nomogram based on multivariable analysis was formulated to predict severe hemorrhage risk for individual patients. Results: A total of 134 patients were identified with a mean treatment-free follow-up period of 2.1 years. bAVM ruptured in 83 (62%) children: 82 had a hemorrhage at presentation and 6 of them experienced a recurrent hemorrhage during follow-up; 1 patient had other diagnostic symptoms but bled during follow-up. Among them, 49% (41/83) had a severe hemorrhage; emergency hematoma evacuation was required in 28% of them (23/83), and 24% (20/83) remained as disabled (mRS ≥3) at last follow-up. Forty-six percent (38/82) of children with hemorrhagic presentation were severely disabled (mRS >3). Forty-three percent (3/7) were severely disabled after subsequent hemorrhage. The annual rate of severe subsequent hemorrhage was 1% in the overall cohort and 3.3% in children with ruptured presentation. All the subsequent severe hemorrhage events occurred in children with severe hemorrhage history (7%, 3/41). Periventricular location, non-temporal lobe location, and long draining vein were predictors for severe hemorrhage in pediatric untreated bAVMs. A nomogram based on bAVM morphology was contracted to predict severe hemorrhage risk for individual patients, which was well calibrated and had a good discriminative ability (adjusted C-statistic, 0.72). Conclusions: Evaluating bAVM morbidity and morphology might be helpful for weighing the risks of untreated bAVM in pediatric patients.

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“…However, there was still no significant association between fMRI navigation and the incidence of S-PFD in the patient subgroups, such as patients with eloquent-area AVMs (p = 0.891) or with low preoperative mRS score (0-1) (p = 0.753). In our previous studies, 18 we have determined that preoperative functional findings derived from BOLD-fMRI and DTI are predictive of surgical outcomes in patients with AVMs. The use of DTI tractography allows assessment of important white matter tracts, and BOLD-fMRI enables functional mapping of at-risk cortex in the vicinity of an AVM.…”

Section: Figmentioning

confidence: 99%

Effect of functional MRI–guided navigation on surgical outcomes: a prospective controlled trial in patients with arteriovenous malformations

Lin

Jiao

et al. 2016

JNS

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OBJECTIVE The impact of functional MRI (fMRI)-guided navigation on the surgical outcome of patients with arteriovenous malformations (AVMs) is undetermined. This large, randomized controlled trial (RCT) was designed to determine the safety and efficacy of fMRI-guided microsurgery of AVMs. This paper reports the preliminary results of the interim analysis. METHODS Between September 2012 and June 2015, eligible patients were randomized to the standard microsurgery group (control group) or the fMRI-guided surgery group (experimental group) in a 1:1 ratio. Patients in the control group underwent conventional digital subtraction angiography and MRI before surgery. The surgery was performed according to the standard procedure. However, patients in the experimental group underwent blood oxygen level-dependent (BOLD) fMRI and diffusion tensor imaging within 1 week before surgery. Moreover, preoperative eloquent brain tissue mapping and intraoperative fMRI navigation were performed in addition to the standard procedure. The preliminary end points were the total removal rate of AVMs and postoperative surgical complications. The primary end points were modified Rankin Scale (mRS) score (favorable: mRS Score 0-2; poor: mRS Score 3-6) and surgery-related permanent functional deficits (S-PFD) at the last clinic visit (≥ 6 months). Statistical analysis was performed using the statistical package from SPSS. RESULTS The interim analysis included 184 participants (93 in the experimental group and 91 in the control group). Patients were equally distributed between the 2 groups. Neither the preliminary nor the primary end points, including postoperative complications (p = 0.781), residual AVM (p = 1.000), last mRS score (p = 0.654), and S-PFD (p = 0.944) showed any significant difference between the control and experimental group. According to the results of the univariate analysis, eloquent adjacent brain tissue (OR 0.14; 95% CI 0.06-0.32; p < 0.001), large size of the nidus (OR 1.05; 95% CI 1.02-1.08; p = 0.002), or diffuse nidus (OR 3.05; 95% CI 1.42-6.58; p = 0.004) were all significantly associated with S-PFD. Additionally, a high Spetzler-Martin score (OR 3.54; 95% CI 2.08-6.02; p < 0.001), no previous hemorrhage (OR 2.35; 95% CI 1.00-5.54; p = 0.05), or a low preoperative mRS score (OR 0.42; 95% CI 0.17-1.00; p = 0.049) were also significantly associated with S-PFD. Multivariate analysis revealed that independent factors correlated with S-PFD were eloquent adjacent brain tissue (OR 0.17; 95% CI 0.04-0.70; p = 0.014) and low preoperative mRS score (OR 0.22; 95% CI 0.07-0.69; p = 0.009). CONCLUSIONS This preplanned interim analysis revealed no significant differences in the primary end points between the experimental and control group, prompting an early termination of this RCT. The preliminary data indicated that the additional intervention of fMRI navigation is not associated with a more favorable surgical outcome in patients with AVMs. The results indicated that eloquent adjacent brain tissue and a low preoperative mRS score...

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Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Cited by 22 publications

References 34 publications

A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations

A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations

Morbidity after Hemorrhage in Children with Untreated Brain Arteriovenous Malformation

Effect of functional MRI–guided navigation on surgical outcomes: a prospective controlled trial in patients with arteriovenous malformations

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