Ménissier A, Petit A, Bougaci N, Hamdan N, Lemoine C, Faddoul J, Thines L
Service de neurochirurgie, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
Service de neurochirurgie, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
Neurochirurgie. 2022 Apr;68(3):320-322. doi: 10.1016/j.neuchi.2021.06.005. Epub 2021 Jun 21.
Cerebral arteriovenous malformations (AVMs) are rare, with incidence of 1.12-1.42 cases per 100,000 person-years (Ozpinar et al., 2017). Few studies report applications of awake surgery. The goal of this report was to assess the interest of awake surgery in complete resection of cortical AVMs located close to eloquent speech areas, enabling detection of real functional cortical reorganization due to the AVM and parenchymal hematoma.
A 38-year-old right-handed patient was admitted to the University Hospital of Besançon for dysphasia due to a ruptured left temporal arteriovenous malformation. The patient underwent asleep-awake-asleep surgery. Intraoperative cortical mapping revealed the presence of functional language areas in uncommon locations compared to known neuro-functional anatomy.
In this patient, speech areas were redistributed, probably due to neuroplasticity after cerebral hemorrhage, leading to a new cortical architecture, which would have been unrecognized based on preoperative radiological imaging alone.
We report the interest of awake surgery to achieve complete safe resection of ruptured AVMs located close to eloquent speech areas, using intraoperative cortical mapping.
脑动静脉畸形（AVM）较为罕见，发病率为每10万人年1.12 - 1.42例（奥兹皮纳尔等人，2017年）。很少有研究报道清醒手术的应用情况。本报告的目的是评估清醒手术对于完全切除位于明确语言区附近的皮质AVM的意义，从而能够检测由于AVM和脑实质血肿导致的真正功能性皮质重组。
一名38岁右利手患者因左侧颞叶动静脉畸形破裂导致吞咽困难入住贝桑松大学医院。该患者接受了先睡眠后清醒再睡眠的手术。术中皮质图谱显示，与已知的神经功能解剖结构相比，功能语言区位于不常见的位置。
在该患者中，语言区重新分布，可能是由于脑出血后的神经可塑性，导致了新的皮质结构，仅根据术前影像学检查是无法识别这种情况的。
我们报告了清醒手术利用术中皮质图谱实现完全安全切除位于明确语言区附近的破裂AVM的意义。
