Background

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.

Case report

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.

Discussion

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.

Conclusion

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.

中文翻译：

---

对靠近言语区域的脑动静脉畸形破裂进行清醒手术的兴趣——手术笔记

背景

脑动静脉畸形 (AVM) 很少见，每 100,000 人年的发病率为 1.12-1.42 例（Ozpinar 等，2017）。很少有研究报告清醒手术的应用。本报告的目的是评估清醒手术对完全切除靠近雄辩语言区域的皮质 AVM 的兴趣，从而能够检测由于 AVM 和实质血肿引起的真正功能性皮质重组。

案例报告

一名 38 岁的右利手患者因左颞动静脉畸形破裂而出现言语障碍，被贝桑松大学医院收治。患者接受了睡眠-清醒-睡眠手术。与已知的神经功能解剖结构相比，术中皮质映射显示在不常见的位置存在功能性语言区域。

讨论

在该患者中，言语区域重新分布，可能是由于脑出血后的神经可塑性，导致新的皮质结构，仅根据术前放射成像无法识别。

结论

我们报告了清醒手术的兴趣，以使用术中皮质标测来实现完全安全切除位于说话能力强区域附近的破裂 AVM。