Integrated pre- and intraoperative imaging in a patient with an arteriovenous malformation located in eloquent cortex

• Published in: Minimally invasive neurosurgery Vol. 52; no. 2; p. 83
• Main Authors: Berntsen, E M, Gulati, S, Solheim, O, Kvistad, K A, Lindseth, F, Unsgaard, G
• Format: Journal Article
• Language: English
• Published: Germany 01.04.2009
• Subjects: Adult; Brain Mapping - methods; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - pathology; Cerebral Arteries - surgery; Cerebral Veins - diagnostic imaging; Cerebral Veins - pathology; Cerebral Veins - surgery; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - surgery; Magnetic Resonance Imaging - methods; Monitoring, Intraoperative - methods; Motor Cortex - pathology; Motor Cortex - surgery; Neuronavigation - methods; Neurosurgical Procedures - instrumentation; Neurosurgical Procedures - methods; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Preoperative Care - methods; Pyramidal Tracts - anatomy & histology; Pyramidal Tracts - surgery; Surgical Instruments; Treatment Outcome; Ultrasonography; Vascular Surgical Procedures - instrumentation; Vascular Surgical Procedures - methods
• ISSN: 1439-2291
• DOI: 10.1055/s-0028-1124104

The use of integrated pre- and intraoperative imaging may be useful when resecting brain lesions in close proximity to eloquent areas, such as the primary motor cortex and language cortices. A 32-year-old woman with an arteriovenous malformation (AVM) located in the primary motor cortex underwent surgery using functional neuronavigation. Blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI) and diffusion tensor tractography (DTT) were used for preoperative mapping of primary motor areas and the corticospinal tracts, respectively. The BOLD fMRI activations and DTT tractograms were integrated into the neuronavigation system and visualized intraoperatively throughout the operation. Furthermore, stereoscopic visualizations of the angioarchitecture based on 3D MRI angiograms were used to rehearse the surgical approach to the feeder vessels. Finally, intraoperative ultrasound was used to locate and clip the feeding vessels. The AVM was carefully resected with the aid of the above-mentioned imaging techniques, and the intuitive usefulness of the techniques was further substantiated by the rewarding postoperative outcome.