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Armocida D, D’Angelo L, Berra LV, Pesce A, di Palma V, Galati G, Frati A, Santoro A. Awake surgery for arteriovenous malformations (AVMs) in eloquent areas does not increase intraoperative risks and allows for shorter-term recovery and improved status. World Neurosurg 2022; 164:e1015-e1023. [PMID: 35643402 DOI: 10.1016/j.wneu.2022.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
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Cezayirli PC, Türe H, Türe U. Microsurgical Treatment of Deep and Eloquent AVMs. Adv Tech Stand Neurosurg 2022; 44:17-53. [PMID: 35107672 DOI: 10.1007/978-3-030-87649-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the past 30 years, the treatment of deep and eloquent arteriovenous malformations (AVMs) has moved away from microneurosurgical resection and towards medical management and the so-called minimally invasive techniques, such as endovascular embolization and radiosurgery. The Spetzler-Martin grading system (and subsequent modifications) has done much to aid in risk stratification for surgical intervention; however, the system does not predict the risk of hemorrhage nor risk from other interventions. In more recent years, the ARUBA trial has suggested that unruptured AVMs should be medically managed. In our experience, although these eloquent regions of the brain should be discussed with patients in assessing the risks and benefits of intervention, we believe each AVM should be assessed based on the characteristics of the patient and the angio-architecture of the AVM, in particular venous hypertension, which may guide us to treat even high-grade AVMs when we believe we can (and need to) to benefit the patient. Advances in imaging and intraoperative adjuncts have helped us in decision making, preoperative planning, and ensuring good outcomes for our patients. Here, we present several cases to illustrate our primary points that treating low-grade AVMs can be more difficult than treating high-grade ones, mismanagement of deep and eloquent AVMs at the behest of dogma can harm patients, and the treatment of any AVM should be tailored to the individual patient and that patient's lesion.
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Affiliation(s)
- Phillip Cem Cezayirli
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
| | - Hatice Türe
- Department of Anesthesiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
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de Souza Coelho D, Fernandes de Oliveira Santos B, Silva da Costa MD, Silva GS, Cavalheiro S, Santos FH, Chaddad-Neto F. Cognitive performance in patients with cerebral arteriovenous malformation. J Neurosurg 2020; 132:1548-1555. [PMID: 31465157 DOI: 10.3171/2018.12.jns181883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A cerebral arteriovenous malformation (cAVM) can change over time and cause symptoms, but clinical studies tend to define only the patients with ruptured cAVMs as symptomatic and do not consider neurocognitive aspects prior to neurosurgical intervention. The objective of this study was to describe the neurocognitive function of patients with ruptured and unruptured cAVMs according to the Spetzler-Martin (SM) grade, flow status, and anatomical topography. METHODS In this blinded cross-sectional study, 70 patients of both sexes and ages 18-60 years were evaluated using the Brazilian Brief Neuropsychological Assessment Battery Neupsilin. RESULTS Of the 70 patients with cAVMs, 50 (71.4%) demonstrated deficits in at least one of the eight neurocognitive domains surveyed, although they did not exhibit neurological deficits. cAVMs in the temporal lobe were associated with memory deficits compared with the general population. The SM grade was not significantly associated with the results of patients with unruptured cAVMs. However, among patients with ruptured cAVMs, there were deficits in working memory in those with high-grade (SM grade) cAVMs and deficits in executive function (verbal fluency) in those with low-grade cAVMs (p < 0.001). CONCLUSIONS This study indicates that patients with untreated cAVMs, either ruptured or unruptured, already exhibit neurocognitive deficits, even the patients without other neurological symptoms. However, the scales used to evaluate disability in the main clinical studies, such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), do not assess neurocognitive alterations and therefore disregard any deficits that may affect quality of life. The authors' finding raises an important question about the effects of interventional treatment because it reinforces the hypothesis that cognitive alterations may be preexisting and not determined by interventions.
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Affiliation(s)
- Daniela de Souza Coelho
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | | | - Gisele Sampaio Silva
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; and
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Dinc N, Won SY, Eibach M, Gessler F, Konczalla J, Quick-Weller J, Seifert V, Marquardt G. The Extent of Neurologic Improvement and Social Life in Young Patients with Ruptured and Unruptured Brain AVM: A Long-Term Follow-Up. World Neurosurg 2019; 127:e503-e508. [PMID: 30928578 DOI: 10.1016/j.wneu.2019.03.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intracerebral hemorrhage, seizures, neurologic deficits, and cognitive impairments due to brain AVM in childhood are incriminating for brain and executive function with sequelae for further social life. Long-term follow-up data on brain AVM in young patients are rare, making it difficult to compare and evaluate treatment risks and outcomes. METHODS We studied young patients with brain AVM who were referred to our institution between 2005 and 2012 and for whom follow-up data were available. We stratified the patients into those with ruptured AVM (rAVM) and unruptured AVM (uAVM) and compared treated and nontreated patients. Differences in outcome and social participation were assessed. RESULTS A total of 29 young patients with brain AVM, median age 16 years, were included in our study with complete follow-up data of over 5 years (mean, 6 years). In 18 (62.1%) patients rAVM and in 11 (37.9%) patients uAVM were found. Twenty (69%) patients received treatment (rAVM 70% vs. uAVM 30%). Among treatment methods, microsurgery was most frequently used (rAVM 33.3% vs. uAVM 36.4%). In rAVM, 16 of 18 (88.9%) patients returned to work or school, and in uAVM, 11 (100%) patients did so. Concerning cognitive problems, no statistically significant difference was found in the 2 groups comparing treated and nontreated patients (P > 0.05). A favorable outcome was achieved in 13 (72.2%) patients with rAVM and in 11 (100%) patients with uAVM. CONCLUSION Favorable outcome was achieved in the majority of patients. The rate of neurologic improvement and participation in social life was very high in the 2 groups.
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Affiliation(s)
- Nazife Dinc
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany.
| | - Sae-Yeon Won
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Michael Eibach
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | | | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
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Berthier ML, Dávila G, Moreno-Torres I, Beltrán-Corbellini Á, Santana-Moreno D, Roé-Vellvé N, Thurnhofer-Hemsi K, Torres-Prioris MJ, Massone MI, Ruiz-Cruces R. Loss of regional accent after damage to the speech production network. Front Hum Neurosci 2015; 9:610. [PMID: 26594161 PMCID: PMC4633569 DOI: 10.3389/fnhum.2015.00610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022] Open
Abstract
Lesion-symptom mapping studies reveal that selective damage to one or more components of the speech production network can be associated with foreign accent syndrome, changes in regional accent (e.g., from Parisian accent to Alsatian accent), stronger regional accent, or re-emergence of a previously learned and dormant regional accent. Here, we report loss of regional accent after rapidly regressive Broca's aphasia in three Argentinean patients who had suffered unilateral or bilateral focal lesions in components of the speech production network. All patients were monolingual speakers with three different native Spanish accents (Cordobés or central, Guaranítico or northeast, and Bonaerense). Samples of speech production from the patient with native Córdoba accent were compared with previous recordings of his voice, whereas data from the patient with native Guaranítico accent were compared with speech samples from one healthy control matched for age, gender, and native accent. Speech samples from the patient with native Buenos Aires's accent were compared with data obtained from four healthy control subjects with the same accent. Analysis of speech production revealed discrete slowing in speech rate, inappropriate long pauses, and monotonous intonation. Phonemic production remained similar to those of healthy Spanish speakers, but phonetic variants peculiar to each accent (e.g., intervocalic aspiration of /s/ in Córdoba accent) were absent. While basic normal prosodic features of Spanish prosody were preserved, features intrinsic to melody of certain geographical areas (e.g., rising end F0 excursion in declarative sentences intoned with Córdoba accent) were absent. All patients were also unable to produce sentences with different emotional prosody. Brain imaging disclosed focal left hemisphere lesions involving the middle part of the motor cortex, the post-central cortex, the posterior inferior and/or middle frontal cortices, insula, anterior putamen and supplementary motor area. Our findings suggest that lesions affecting the middle part of the left motor cortex and other components of the speech production network disrupt neural processes involved in the production of regional accent features.
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Affiliation(s)
- Marcelo L. Berthier
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Ignacio Moreno-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
- Department of Spanish Language I, University of MalagaMalaga, Spain
| | - Álvaro Beltrán-Corbellini
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Daniel Santana-Moreno
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Karl Thurnhofer-Hemsi
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
- Department of Applied Mathematics, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - María Ignacia Massone
- Centro de Investigaciones en Antropología Filosófica y Cultural, Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | - Rafael Ruiz-Cruces
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
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Lee L, Sitoh YY, Ng I, Ng WH. Cortical reorganization of motor functional areas in cerebral arteriovenous malformations. J Clin Neurosci 2013; 20:649-53. [DOI: 10.1016/j.jocn.2012.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/14/2012] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
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Morrison CE, Nakhutina L. Neuropsychological features of lesion-related epilepsy in adults: an overview. Neuropsychol Rev 2007; 17:385-403. [PMID: 17952606 DOI: 10.1007/s11065-007-9044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/03/2007] [Indexed: 11/26/2022]
Abstract
Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.
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Affiliation(s)
- Chris E Morrison
- Department of Neurology, Comprehensive Epilepsy Center, New York University Medical Center, 403 E 34th St., 4th Floor, New York, NY, 10016, USA.
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Abstract
The therapeutic potential of intra-arterial (IA) drug delivery to the brain has received limited attention in the last decade. In the 1980s, efforts to treat brain tumors with IA chemotherapy, the leading application of this technology, yielded modest results. Poor control of tissue drug concentrations and the potential risk of permanent neurologic injury further prevented the wider use of IA drugs. Yet, IA drugs were anecdotally used for treating a wide spectrum of brain diseases. Recent advances in endovascular technology and the increased safety of angiographic procedures now compel us to reevaluate IA drug delivery. This review describes the pharmacologic principles, applications, and pitfalls of IA drug delivery to the brain.
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Affiliation(s)
- Shailendra Joshi
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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