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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Keynote lecture: Surgical treatment of artero-venous malformations in/around speech areas

Meeting Abstract

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  • Alberto Pasqualin - Istituto di Neurochirurgia, SSO Neurochirurgia Vascolare, Azienda Ospedaliera, Verona, Italy
  • Aurel Hasanbelliu - Istituto di Neurochirurgia, SSO Neurochirurgia Vascolare, Azienda Ospedaliera, Verona, Italy
  • Pietro Meneghelli - Istituto di Neurochirurgia, SSO Neurochirurgia Vascolare, Azienda Ospedaliera, Verona, Italy
  • Piergiuseppe Zampieri - Servizio di Neuroradiologia, Azienda Ospedaliera, Verona, Italy
  • Antonio Nicolato - SSO di Radiochirurgia Stereotassica, Azienda Ospedaliera, Verona, Italy

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.21.01

doi: 10.3205/15dgnc220, urn:nbn:de:0183-15dgnc2207

Published: June 2, 2015

© 2015 Pasqualin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Surgical treatment of AVMs in/around speech areas remains controversial. The old concept of "essential" language areas is debatable, especially considering the recent advances in tractography and the experience with direct cortical stimulation during awake craniotomies. In this study, we aimed to evaluate the results of surgical treatment for AVMs in the left pery-sylvian area, with special care to the occurrence of postop speech deficits.

Method: A total of 58 patients with AVMs located in/around speech areas were operated on by the senior author from 1990 to 2014, out of a total 297 patients with cerebral AVMs operated on in the same period. Clinical history was constituted by epilepsy in 48% of cases, and hemorrhage in 45% of cases (with significant preop deficits in 6 cases). The AVM was located in the Broca's area and mid-posterior frontal operculum in 17 cases (6 with AVMs > 20cm3), in the inferior parietal lobule in 8 cases (2 with AVMs > 20cm3), in the mid-posterior superior temporal gyrus and temporal operculum in 25 cases (5 with AVMs 20cm3) and in the insular region in 8 cases. fMRI and more recently tractography were performed preoperatively in the last years. Preoperative embolisation was adopted in 24 patients (and mostly for AVMs 10cm3); 5 of these patients underwent also radiosurgery before surgical removal. Two additional patients were submitted to radiosurgery before surgical removal.

Results: After surgery, 10 patients presented hyperemic complications, requiring surgical evacuation in 3 cases; in mosto f these cases the AVM was over 20cm3. transient deficits were observed in 45% of cases. There was no mortality. At 6 month follow-up, 16 patients presented permanent deficits, of which 7 were pre-existing and 9 developed after surgery (only 2 of them with mRS above 2).

Conclusions: It is concluded that microsurgery constitutes a reasonable therapeutic option in patients with AVMs in/around speech areas, especially when the AVM volume is under 20cm3. alternative tratments (embolisation + radiosurgery, or staged radiosurgery) may be advisable for AVMs in/around speech areas with volume over 20cm3.