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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Impacting treatment of brain AVMs by nTMS

Meeting Abstract

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  • Sebastian Ille - Neurochirurgische Klinik, Klinikum rechts der Isar, TU München, München, Deutschland
  • Thomas Picht - Berlin, Deutschland
  • Bernhard Meyer - München, Deutschland
  • Peter Vajkoczy - Berlin, Deutschland
  • Sandro M. Krieg - München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.11.02

doi: 10.3205/17dgnc236, urn:nbn:de:0183-17dgnc2363

Published: June 9, 2017

© 2017 Ille 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

Text

Objective: The treatment of brain arteriovenous malformations (BAVM) is still contrarily discussed. Despite the debatable results of the ARUBA trial, most BAVMs still require treatment depending on the Spetzler-Martin (SM) grading. Since size is measurable and venous drainage is visible, the determination of eloquence is crucial. In the present study the influence of data from navigated transcranial magnetic stimulation (nTMS) on decision-making for or against treatment of BAVMs was examined by confirming / falsifying presumed eloquence.

Methods: We pooled a consecutive bicentric series of 34 patients (20 male) with BAVMs (cases/SM grade: 5/I, 12/II, 14/III, 2/IV, 1/V). In all cases we performed nTMS mappings (20 motor, 16 repetitive nTMS language mappings) before the treatment decision.

Results: The results of nTMS changed the SM grading in 6 cases (1/I, 4/II, 1/III). In 2 cases the SM grading changed to a lower grade, in 4 cases the SM grading changed to a higher grade due to nTMS mappings. Out of all 34 cases, indication for surgery was based on nTMS mappings in 13 cases (38%; 2/I, 4/II, 6/III, 1/IV; 6 motor, 7 language mappings). In 6 cases (18%; 3/II, 3/III) the decision against surgery was made based on nTMS mappings (3 motor, 3 language). Six patients (24%) suffered from transient, and 3 patients (12%) suffered new surgery-related permanent motor or language deficits.

Conclusion: In 19 of 34 cases nTMS was the decisive argument. We could show that nTMS motor and language data can be used for decision-making regarding the treatment of BAVMs and for a more detailed SM grading regarding the rating of eloquence. However, the reliability of the present results has to be confirmed by a larger series and a randomized trial.