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24.01.2018 | Original Article - Vascular | Ausgabe 3/2018

Acta Neurochirurgica 3/2018

The impact of nTMS mapping on treatment of brain AVMs

Zeitschrift:
Acta Neurochirurgica > Ausgabe 3/2018
Autoren:
Sebastian Ille, Thomas Picht, Ehab Shiban, Bernhard Meyer, Peter Vajkoczy, Sandro M. Krieg
Wichtige Hinweise
Sebastian Ille, Thomas Picht, Peter Vajkoczy, and Sandro M. Krieg contributed equally to this study.

Previous presentations

Portions of this work were presented in oral presentation form at the annual meeting of the German Society of Neurosurgery (DGNC), Magdeburg, Germany, May 16, 2017 and at the annual meeting of the European Association of Neurosurgical Societies (EANS), Venice, Italy, October 2, 2017, in poster form at the annual meeting of the American Association of Neurological Surgeons, Los Angeles, California, USA, April 24, 2017

Comments

This is an excellent study. I personally am surprised of the number of cases that may have a change in treatment recommendations arising as a consequence of this investigation (given the very low morbidity for SPC A without this assessment). However, the study is soundly based, well conducted, and well analyzed. This assessment technique may enhance the safety of AVM surgery and, therefore, is very important.
Michael Morgan
Sydney, Australia

Abstract

Background

The treatment of brain arteriovenous malformations (BAVMs) 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 comparably crucial but not fully objective. The present bicentric cohort study aims to examine the influence of preoperative navigated transcranial magnetic stimulation (nTMS) motor and language mapping data on decision-making for or against surgical treatment of BAVMs.

Methods

The influence of data from nTMS on decision-making for or against treatment of BAVMs was examined by confirming/falsifying presumed motor or language eloquence.

Results

The results of nTMS mappings changed the SM grading in nine cases. In six cases, the SM grading changed to a lower grade (= falsified eloquence); in three cases, the SM grading changed to a higher grade due to nTMS mappings (= unexpected eloquence). Out of all 34 cases, indication for surgery was supported by nTMS mappings in 15 cases (7 motors, 8 languages). In six cases, the decision against surgery was made based on nTMS mappings (three motors, three languages).

Conclusion

In 21 of 34 cases (62%), nTMS was a supportive argument. We could show that nTMS motor and language data can be used for a more objective decision-making regarding the treatment of BAVMs and for a more detailed SM grading regarding the rating of eloquence.

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