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Functional brain map** of patients with arteriovenous malformations using navigated transcranial magnetic stimulation: first experience in ten patients

  • Clinical Article - Functional
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Abstract

Background

Intracranial arteriovenous malformations (AVM) are known to be potent inductors of functional plasticity, and their vasculature makes standard functional imaging difficult. Here we conducted functional map** of both primary motor cortex and speech related areas in patients with AVM using navigated transcranial magnetic stimulation (nTMS), which has been recently proven as a reliable noninvasive modality of preoperative functional brain map**.

Method

nTMS map** was performed in ten patients with unruptured intracranial AVMs located in or near eloquent areas. Motor map** was conducted for six patients with AVMs near the rolandic region, and speech map** was performed for four patients with left perisylvian AVMs. After the examination, all patients were treated with surgery, radiosurgery or observed with best medical treatment on case-by-case basis.

Results

Motor map** allowed for delineation of the primary motor cortex, even if the anatomy was severely obscured by the AVM in all cases with rolandic AVMs. No plastic relocation of the primary motor cortex was observed. Repetitive stimulation of the left ventral precentral gyrus led to speech impairments in all four cases that underwent speech map**. Right hemispheric involvement was observed in one out of four cases and potentially indicated plastic changes. No side effects were observed.

Conclusion

nTMS allowed for detailed delineation of eloquent areas even within hypervascularized cortical areas. Our observations indicate that nTMS functional map** is feasible not only in tumorous brain lesions, but also in AVMs.

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Acknowledgments

The work was in part supported by a grant from the Berlin Cancer Society.

Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Naoki Kato, Sarah Schilt, Heike Schneider, Dietmar Frey, Peter Vajkoczy & Thomas Picht

  2. Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Markus Kufeld

  3. Department of Neurosurgery, Jikei University School of Medicine Tokyo, 3-25-8, Nishi-shinbashi, Minato-ku, 105-8461, Tokyo, Japan

    Naoki Kato

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  1. Naoki Kato
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  2. Sarah Schilt
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Correspondence to Naoki Kato.

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Kato, N., Schilt, S., Schneider, H. et al. Functional brain map** of patients with arteriovenous malformations using navigated transcranial magnetic stimulation: first experience in ten patients. Acta Neurochir 156, 885–895 (2014). https://doi.org/10.1007/s00701-014-2043-7

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  • DOI: https://doi.org/10.1007/s00701-014-2043-7

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