Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient.
J Neurosurg Pediatr
; 14(1): 38-42, 2014 Jul.
Article
en En
| MEDLINE
| ID: mdl-24866824
ABSTRACT
Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2-3 (proximal) and 2-4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.
Palabras clave
AChA = anterior choroidal artery; AVM = arteriovenous malformation; EVD = external ventricular drain; GCS = Glasgow Coma Scale; HS = hemorrhagic stroke; ICA = internal carotid artery; MCA = middle cerebral artery; MEG = magnetoencephalography; MRA = MR angiography; MRC = Medical Research Council; PCA = posterior cerebral artery; TMS = transcranial magnetic stimulation; VP = ventriculoperitoneal; arteriovenous malformation; brain mapping; eloquent area; fMRI = functional MRI; microsurgical resection; outcome; pediatric hemorrhagic stroke; vascular disorders
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Malformaciones Arteriovenosas Intracraneales
/
Derivación Ventriculoperitoneal
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Estimulación Magnética Transcraneal
/
Hidrocefalia
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Límite:
Adolescent
/
Child
/
Humans
/
Male
Idioma:
En
Revista:
J Neurosurg Pediatr
Asunto de la revista:
NEUROCIRURGIA
/
PEDIATRIA
Año:
2014
Tipo del documento:
Article