gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Surgical management of arteriovenous malformations in eloquent motor areas: the contribution of functional imaging and intraoperative monitoring

Meeting Abstract

  • Guilherme Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Jürgen Honegger - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Marina Liebsch - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Kristofer Fingerle Ramina - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Thomas Nägele - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen
  • Ulrike Ernemann - Abteilung für Neuroradiologie, Universitätsklinikum Tübingen
  • Marcos Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 153

doi: 10.3205/14dgnc547, urn:nbn:de:0183-14dgnc5478

Published: May 13, 2014

© 2014 Lepski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Arteriovenous malformations (AVMs) proximal to motor cortical areas or motor projection systems are challenging to manage due to the risk of severe sensory and motor impairment. Surgical indication in these cases therefore remains controversial. In this study, a standardized approach was proposed for centrally situated AVMs, based on functional imaging and intraoperative electrophysiological evaluation.

Method: We conducted a retrospective analysis of 15 patients who underwent surgical treatment for AVMs in motor cortical areas or proximal to motor projections. Preoperative assessment included fMRI and 3D-tractography. Operations were performed under continuous electrophysiological monitoring aided by direct brain stimulation. We identified critical blood supply to the motor areas by temporary occluding the feeding vessels under electrophysiological monitoring. Clinical outcome was evaluated using the modified Rankin Scale.

Results: Total resection was achieved in 13 cases, while electrophysiology limited total extirpation in 2 subjects. A significant reduction of motor evoked potentials (MEPs) by up to 15% of the initial values was associated with good recovery of motor function; by contrast, the disappearance of potentials correlated with long-term impairment. The mean follow-up time was 13 months, and clinical assessments revealed overall functional improvement (p<0.05). After surgery, 11 patients were asymptomatic or presented only with minor neurological deficits.

Conclusions: These results demonstrate that surgical resection of AVMs in eloquent motor areas can be considered a safe option for selected cases when performed in conjunction with a detailed functional assessment. Possible selection criteria for surgical treatment are discussed in light of the presented clinical data.