CEREBRAL VASCULAR MALFORMATIONS AND TUMORS IN THE ELOQUENT BRAIN AREAS: RADIOLOGICAL CRITERIA FOR NEUROSURGICAL TREATMENT

Keywords: cerebral vascular malformations; arteriovenous malformations; cavernous malformations; brain tumors; MR tractography; surgical treatment; structure

Abstract

Introduction. We believe, that in the planning of the surgical removal of cerebral vascular malformations (CVM) of eloquent brain areas, a question of whether they include the functionally sustainable brain tissue remains relevant. The question of whether the surgical procedure is safe is paramount.

Aim. To assess the value of magnetic resonance (MR) tractography in deciding on the tactics of surgical treatment of CVM through  comparison with morphological studies.

Study methods. A review of the literature concerning the surgical treatment of cavernous malformations (CM) and arteriovenous malformations (AVM) localized in eloquent brain areas (EBA). Four patients with CVM of EBA were selected based on the availability of MR tractography data and histologic specimens. The method of optical microscopy was used to study microslides stained with the classic (hematoxylin-eosin) and specialized methods (Masson’s and Hart’s methods).

Results. Patients’ MR-tractography data showed the presence of conductive paths in the tissues of CM and AVM and the reduced fractional anisotropy in the regions of interest, which indicates their involvement. During optical microscopy of specimens of CVMs, we found brain tissues between pathological vessels. To our opinion, this explains the visualization of conducting paths in CVMs during MR tractography.

Conclusions. When planning surgeries in case of CVMs, attention should be paid to the results of conductive path visualization. According to MR tractography and morphological data, in some cases, there is brain parenchyma in the structure of CMs and AVMs, which may require additional attention in deciding on the radical resection of CVMs of EBAs.

Downloads

Download data is not yet available.

References

Baranoski JF, Kalani MY, Przybylowski CJ, Zabramski JM. Cerebral cavernous malformations: review of the genetic and protein-protein interactions resulting in disease pathogenesis. Front Surg. 2016; 3:60. doi: 10.3389/fsurg.2016.00060.

https://doi.org/10.3389/fsurg.2016.00060

Anne G. Osborn. Pathology of the craniocervical vasculature. Vascular malformations. In: Diagnostic Cerebral Angiography: 2nd (second) Edition. Hardcover - Lippincott Williams & Wilkins. 1999; 277-313.

Konovalov AN, Blinkov SM, Pucyllo MV. Neurosurgical anatomy in pathology. Arterial and arteriovenous aneurysms. In: Atlas of Neurosurgical Anatomy. Moscow: Medicine. 1990. 115-162.

Barker JH, Anderson GL, Menger MD. Clinically Applied Microcirculation Research. Chapter V. Functional Components of the Microcirculation. Pp 317-481. Routledge Revivals. Routledge, 2019. 496 p.

https://doi.org/10.4324/9780429261312

Vinay Kumar, Abul Abbas, Jon Aster. Robbins Basic Pathology. Vol. 2; 10th Edition (Ukrainian transla- tion). Central nervous system. Cerebrovascular diseases. Kyiv: Medicine. 2020: 464-470.

Cortés Velaa JJ, Concepción Aramendíab L, Ballenilla Marcob F, Gallego Leónb JI, González-Spínola San Gila J. Cerebral cavernous malformations: Spectrum of neuroradiological findings. Radiologia. 2012:54(5):401-9/ DOI: 10.1016/j.rxeng.2011.09.004

https://doi.org/10.1016/j.rxeng.2011.09.004

Tsymbaliuk V, Tsimeyko O, Yakovenko L, Kostiuk M, Kostiuk K. Surgical treatment of symptomatic epilepsy in patients with brain cavernomas. Ukr Neurosurg J [Internet]. 2013Sep.27 [cited 2021Sep.13];(3):25-

https://doi.org/10.25305/unj.54144

Available from: http://theunj.org/article/view/54144

Taslimi S, Modabbernia A, Amin-Hanjani S, Barker FG, Macdonald RL. Natural history of cavernous mal- formation: systematic review and meta-analysis of 25 studies.Neurology. 2016; 86:1984-1991. doi: 10.1212/WNL.0000000000002701.

https://doi.org/10.1212/WNL.0000000000002701

Gotko A, Kivelev J, Son A. Brain and spinal cavernous malformations. Ukr Neurosurg J [Internet]. 2013Sep.27 [cited 2021Sep.13];(3):10-5. Available from: http://theunj.org/article/view/54141

https://doi.org/10.25305/unj.54141

Handbook of Neurosurgery 9th Edition (2020) (PDF) by Mark S. Greenberg. Thieme, 2020. 1784 p.

Robak KO, Chuvashova OYu, Glavatsky AY. Assignment of data of diffusion-tensor tomography and MR-tractography in neurosurgery of glioma of the motor area of the brain. Neurology and Neurosurgery Eastern Europe. 2016; 6 (3): 341−346.

Smolanka VI, Polishchuk ME, Wozniak OM, Oblivach AA, Smolanka AV, Gavrilov TS. Surgical treatment of subtentorial cavernomas of the brain. Ukrainian Journal of Minimally Invasive and Endoscopic Sur- gery. 2015; Vol. 19; 2-3: 5-9.

Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, et al. Management of Brain Arteriovenous Malformations. A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Associatio. Stroke. 2017;48:e00-e00. DOI: 10.1161/ STR.0000000000000134. Available at: http://stroke.ahajournals.org/ by guest on May 7, 2018

https://doi.org/10.1161/STR.0000000000000134

Torsten B. Moeller, Emil Reif. Pocket atlas of radiographic anatomy, third edition. Spetial studies. Thieme. 2010; 356-400.

Wang C.-C., Liu A., Zhang J.-T., Sun B., and Zhao Y.-L. Surgical management of brain-stem cavernous malformations: report of 137 cases. Surgical Neurology. 2003; 59(6): 444-454.

https://doi.org/10.1016/S0090-3019(03)00187-3

Stapleton ChJ, Barker II FG. Cranial Cavernous Malformations Natural History and Treatment. Stroke. 2018;49:1029-1035. DOI: 10.1161/STROKEAHA.117.017074.

https://doi.org/10.1161/STROKEAHA.117.017074

Akers A., Al-Shahi Salman R., A Awad I., Dahlem K., Flemming K., Hart B., et al. Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Pan- el. Neurosurgery. 2017;80(5):665-680. doi: 10.1093/neuros/nyx091.

https://doi.org/10.1093/neuros/nyx091

Patel AP, Amin-Hanjani S, Ogilvy ChS. Schmidek and Sweet Operative Neurosurgical Techniques Indica- tion. Chapter 81. Surgical Management of Cavernous Malformations of the Nervous System [Internet]. Published on 13/03/2015 [cited 2021Sep.13] Available from: https://clinicalgate.com/surgical-man- agement-of-cavernous-malformations-of-the-nervous-system/

Mouchtouris N, Chalouhi N, Chitale A, Starke RM, Tjoumakaris SI, Rosenwasser RH., et al. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment. e Scientific World Journal. Volume 2015, Article ID 808314, 8 pages. http://dx.doi.org/10.1155/2015/808314

https://doi.org/10.1155/2015/808314

Netlyukh AM. Arginine level changes after hemmorrhagic stroke caused by cerebral arterial aneurysm ruptureActa Medica Leopoliensia. 2013; 2: C. 4-7.

Polkovnikov O.YU, Tyagly SV, Savchenko EI, Ksenzov A.YU, Materuhin AM. Hypervascular tumors of craniovertebral junction complex surgical treatment/ Ukrainian interventional neuroradiology and sur- gery. 2014. №1 (7). URL: https://cyberleninka.ru/article/n/kompleksnoe-hirurgicheskoe-lechenie-gi- pervaskulyarizirovannyh-opuholey-kraniovertebralnogo-perehoda (access date: 13.09.2021).

Poorthuis MHF, Klijn CJM, Algra A, Rinkel GJE, Al-Shahi Salman R. Treatment of cerebral cavernous mal- formations: a systematic review and meta-regression analysis. Journal of Neurology, Neurosurgery & Psychiatry, 2014; 85.12: 1319-1323. http://dx.doi.org/10.1136/jnnp-2013-307349.

https://doi.org/10.1136/jnnp-2013-307349


Abstract views: 75
PDF Downloads: 163
Published
2022-06-27
How to Cite
1.
Netliukh A, Malysheva T, Kobyletskyi O, Falion R, Dutka I, Komnatska I. CEREBRAL VASCULAR MALFORMATIONS AND TUMORS IN THE ELOQUENT BRAIN AREAS: RADIOLOGICAL CRITERIA FOR NEUROSURGICAL TREATMENT. Proc Shevchenko Sci Soc Med Sci [Internet]. 2022Jun.27 [cited 2022Oct.7];66(1). Available from: https://mspsss.org.ua/index.php/journal/article/view/660