Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;6(3):441-448.
doi: 10.1136/svn-2020-000591. Epub 2021 Feb 16.

Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding

Yuming Jiao  1   2   3   4 , Hao Li  1   2   3   4 , Weilun Fu  1   2   3   4 , Jiancong Weng  1   2   3   4 , Ran Huo  1   2   3   4 , Yinyan Wang  1   2   5 , Shuo Wang  1   2   3   4 , Tao Jiang  6   2   5 , Yong Cao  6   2   3   4 , Ji Zong Zhao  1   2   3   4
Affiliations

Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding

Yuming Jiao et al. Stroke Vasc Neurol. 2021 Sep.

Abstract

Objective: Surgical management of arteriovenous malformations (AVMs) involving motor cortex or fibre tracts (M-AVMs) is challenging. This study aimed to construct a classification system based on nidus locations and anterior choroidal artery (AChA) feeding to pre-surgically evaluate motor-related and seizure-related outcomes in patients undergoing resection of M-AVMs.

Methods and materials: A total of 125 patients who underwent microsurgical resection of M-AVMs were retrospectively reviewed. Four subtypes were identified based on nidus location: (I) nidus involving the premotor area and/or supplementary motor areas; (II) nidus involving the precentral gyrus; (III) nidus involving the corticospinal tract (CST) and superior to the posterior limb of the internal capsule; (IV) nidus involving the CST at or inferior to the level of posterior limb of the internal capsule. In addition, we divided type IV into type IVa and type IVb according to the AChA feeding. Surgical-related motor deficit (MD) evaluations were performed 1 week (short-term) and 6 months (long-term) after surgery.

Results: The type I patients exhibited the highest incidence (62.0%) of pre-surgical epilepsy among the four subtypes. Multivariate analysis showed that motor-related area subtypes (p=0.004) and diffuse nidus (p=0.014) were significantly associated with long-term MDs. Long-term MDs were significantly less frequent in type I than in the other types. Type IV patients acquired the highest proportion (four patients, 25.0%) of long-term poor outcomes (mRS >2). Type IVb patients showed a significantly higher incidence of post-surgical MDs than type IVa patients (p=0.041). The MDs of type III or IV patients required more recovery time. Of the 62 patients who had pre-surgical seizures, 90.3% (56/62) controlled their seizures well and reached Engel class I after surgery.

Conclusions: Combining the consideration of location and AChA feeding, the classification for M-AVMs is a useful approach for predicting post-surgical motor function and decision-making.

Keywords: arteriovenous malformation.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Classification of motor-related eloquent areas on different planes. (A) On axial plane; (B) on coronal plane; (C) on sagittal plane. Type I, nidus involving premotor area and/or supplementary motor areas; type II, nidus involving the precentral gyrus; type III, nidus involving the corticospinal tract (CST) and superior to the posterior limb of the internal capsule; type IV, nidus that invaded the CST at or inferior to the level of posterior limb of the internal capsule. Asterisk refers to the level of internal capsule.
Figure 2
Figure 2
Poor surgical outcomes of arteriovenous malformations located in motor-related areas involving different motor-related area subtypes. The x-axis indicates the motor-related area subtypes. The y-axis indicates the percentage of good and poor surgical outcomes (*p<0.05).
Figure 3
Figure 3
Recovery time of motor deficits in arteriovenous malformations (AVMs) located in motor-related areas involving different motor-related area subtypes. (A) Kaplan-Meier survival plots for AVMs according to months of motor deficit recovery. The x-axis indicates completed months of follow-up. (B) Bar graph showing the average recovery time of different motor-related area subtypes (*p<0.01; ***p<0.001).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986;65:476–83. 10.3171/jns.1986.65.4.0476 - DOI - PubMed
    1. Jiao Y, Lin F, Wu J, et al. . A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations. J Neurosurg 2018;128:530–40. 10.3171/2016.10.JNS161415 - DOI - PubMed
    1. Jiao Y, Lin F, Wu J, et al. . Brain arteriovenous malformations located in premotor cortex: surgical outcomes and risk factors for postoperative neurologic deficits. World Neurosurg 2017;105:432–40. 10.1016/j.wneu.2017.05.146 - DOI - PubMed
    1. Picard N, Strick PL. Activation of the supplementary motor area (SMA) during performance of visually guided movements. Cereb Cortex 2003;13:977–86. 10.1093/cercor/13.9.977 - DOI - PubMed
    1. Chouinard PA, Paus T. The primary motor and premotor areas of the human cerebral cortex. Neuroscientist 2006;12:143–52. 10.1177/1073858405284255 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources