Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient

Abstract

<jats:p>Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2–3 (proximal) and 2–4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.</jats:p>

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

“…Ille et al ( 188 ) reported their experience of utilizing nTMS to fix the mapping result of fMRI. Kronenburg et al ( 189 ) reported the utilization of TMS to non-cooperative patients and achieved satisfactory results. Although nTMS is widely applied in brain tumors, it has seldom been used for cerebrovascular disease.…”

Patient-reported experience measures in patients undergoing navigated transcranial magnetic stimulation (nTMS): the introduction of nTMS-PREMs

“…Over the last decade, nTMS has been used by neurosurgeons to map functional areas of the brain for surgical planning in neuro-oncology [5,22], AVM resection [7,9,16], and epilepsy [13]. A successful nTMS depends largely on patient cooperation, with a long duration of the exam and fatigue or discomfort potentially affecting the results of the mapping.…”

Awake Craniotomy for a Ruptured Arteriovenous Malformation With Preoperative Navigated Transcranial Magnetic Stimulation for Language Mapping: 2-Dimensional Operative Video

“…The patient experienced significant dysphasia in the immediate postoperative period which improved by postoperative day 3, with near total resolution by postoperative day 14. nTMS may be a useful modality for noninvasive preoperative functional mapping of speech in patients with AVMs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]…”