gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Awake craniotomy for resection of a cerebral AVM within Broca's area

Meeting Abstract

  • L. Füllbier - Neurochirurgische Klinik des Klinikums Stuttgart
  • H. Henkes - Neuroradiologische Klinik des Klinikums Stuttgart
  • N. Hopf - Neurochirurgische Klinik des Klinikums Stuttgart
  • C. Musahl - Neurochirurgische Klinik des Klinikums Stuttgart

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 001

DOI: 10.3205/11dgnc222, URN: urn:nbn:de:0183-11dgnc2223

Published: April 28, 2011

© 2011 Füllbier et al.
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Outline

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Objective: Awake craniotomies are frequently used for the resection of primary brain tumors in eloquent brain areas, while hardly any reports about awake AVM resection exist in the literature. We present a case of a 43-year-old woman that originally presented with a bilateral tinnitus. Catheter angiography revealed a fronto-temporal AVM Spetzler-Martin Grade IV adjacent to Broca´s area. Applying multiple endovascular partial embolizations, our neuroradiologists were able to reduce the AVM in size but with unchanged relation to Broca's area.

Methods: Operative total resection of the AVM was intended, using neuronavigation for planning of a minimally invasive approach. Continuous monitoring of evoked sensory and motor potentials was applied as well as speech testing by a speech therapist. After opening of the dura, Broca's area was identified by direct cortical stimulation. During preparation of the Sylvian fissure the patient complained of numbness of the right leg, which was followed by decreased motor and sensory evoked potentials. Removal of a frontal brain retractor led to normalization of potentials and vanishing of symptoms. Resection of the AVM was carried out through until further resection would inevitably have led to Broca's aphasia.

Results: The patient tolerated the surgery well. All intraoperative deficits were temporary and resolved completely during surgery. No new neurologic deficit occurred postoperatively. As expected, postoperative angiography showed a small residual of the AVM, so that stereotactic radiosurgery was initiated.

Conclusions: Awake craniotomies for the resection of AVMs in eloquent brain areas are feasible. Brain swelling does not present a significant problem in the presence of an experienced neuroanesthesiologist. Continuous monitoring of the patient is essential using both sensory and motor evoked potentials as well as speech testing by an experienced speech therapist. If complete resection inevitably will lead to neurologic deterioration, alternative options such as radiosurgery should be considered.