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Minim Invasive Neurosurg 2009; 52(2): 83-85
DOI: 10.1055/s-0028-1124104
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Integrated Pre- and Intraoperative Imaging in a Patient with an Arteriovenous Malformation Located in Eloquent Cortex

E. M. Berntsen 1 , 2 , S. Gulati 3 , O. Solheim 3 , K. A. Kvistad 1 , 2 , F. Lindseth 4 , 5 , G. Unsgaard 1 , 4 , 6
  • 1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  • 2Department of Medical Imaging, St. Olav’s Hospital, Trondheim, Norway
  • 3Department of Neurosurgery, St. Olav’s Hospital, Trondheim, Norway
  • 4National Centre for 3D Ultrasound in Surgery, St. Olav’s Hospital, Trondheim, Norway
  • 5SINTEF Health Research, Trondheim, Norway
  • 6Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
Further Information

Publication History

Publication Date:
18 May 2009 (online)

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Abstract

Introduction: 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.

Case Report: 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.

Conclusion: 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.

Key words

functional neuronavigation - BOLD fMRI - DTT - radiology

References

  • 1 Spetzler RF, Martin NA. A proposed grading system for arteriovenous-malformations.  J Neurosurg. 1986;  65 476-483
    Search in Google Scholar
  • 2 Greenberg MS. Radiation Therapy. In: Handbook of Neurosurgery. Green-berg MS, ed. New York: Thieme 2006
  • 3 Gronningsaeter A, Kleven A, Ommedal S. et al . SonoWand, an ultrasound-based neuronavigation system.  Neurosurgery. 2000;  47 1373-1379
    CrossrefPubMedSearch in Google Scholar
  • 4 Latchaw RE, Hu XP, Ugurbil K. et al . Functional magnetic-resonance-imaging as a management tool for cerebral arteriovenous-malformations.  Neurosurgery. 1995;  37 619-625
    CrossrefPubMedSearch in Google Scholar
  • 5 Yamada K, Kizu O, Ito H. et al . Tractography for an arteriovenous malformation.  Neurology. 2004;  62 669
    PubMedSearch in Google Scholar
  • 6 Unsgaard G, Ommedal S, Rygh OM. et al . Operation of arteriovenous malformations assisted by stereoscopic navigation-controlled display of preoperative magnetic resonance angiography and intraoperative ultrasound angiography.  Neurosurgery. 2005;  56 ((2 Suppl)) 281-290 , discussion 290
    PubMedSearch in Google Scholar

Correspondence

E. M. Berntsen

Department of Circulation and Medical Imaging

Faculty of Medicine

NTNU

Medisinsk teknisk forskningssenter

Trondheim

Sør-Trøndelag 7489

Norway

Phone: +47/93/45 85 59

Fax: +47/73/86 77 08

Email: emb@stud.ntnu.no