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(Stroke. 1997;28:1130-1137.)
© 1997 American Heart Association, Inc.

Articles

Cerebral Vascular Malformations Adjacent to Sensorimotor and Visual Cortex

Functional Magnetic Resonance Imaging Studies Before and After Therapeutic Intervention

Michael J. Schlosser, BS; Gregory McCarthy, PhD; Robert K. Fulbright, MD; John C. Gore, PhD; Issam A. Awad, MD

From the Neuropsychology Laboratory, Veterans Administration Medical Center, West Haven (M.J.S., G.M.), and the Neurovascular Surgery Program, Department of Neurosurgery (M.J.S., I.A.A.), and the Department of Diagnostic Radiology (R.K.F., J.C.G.), Yale University School of Medicine, New Haven, Conn.

Correspondence to Issam A. Awad, MD, Neurovascular Surgery Program, Department of Neurosurgery, 333 Cedar St, TMP 405, Yale University School of Medicine, New Haven, CT 06520. E-mail issam.awad{at}yale.edu

Background and Purpose It is not known how cerebral vascular malformations affect the function of the surrounding brain. Functional magnetic resonance imaging (fMRI) can provide information about normal functional neuroanatomy and its alteration by vascular lesions and therapeutic intervention.

Methods We performed fMRI studies in 24 patients harboring vascular malformations adjacent to primary somatosensory, motor, and visual cortex. The fMRI studies consisted of the acquisition of an image time series coupled with functional activation of motor, sensory, or visual cortex in both hemispheres. Activated voxels were identified using frequency domain analyses, and their number and anatomic location were compared between the affected and unaffected hemispheres.

Results Every patient capable of performing the desired task showed functional activation. Eight patients without neurological deficits showed a symmetrical pattern of activation between the hemispheres. Each had a vascular malformation located one or more gyri from the functional region imaged. Three patients showed hemispheric symmetry in the location of activated cortex but with a marked asymmetry in the number of activated voxels. Each harbored vascular malformations located within one gyrus of the functional region and showed either subtle or no neurological deficit. Eleven patients showed hemispheric asymmetry in the location of activated cortex. In 6, the anatomic displacement appeared to be due to a mass effect of the lesion. In 5, the activation occurred at a different anatomic locale, and the patients exhibited gross neurological deficit in the respective function. Posttherapeutic changes in functional activation reflected elimination of the mass effect or recovery of clinical function.

Conclusions Systematic fMRI studies are possible in patients with vascular malformations in brain regions adjacent to primary somatosensory, motor, and visual cortex. Displacement of the activated region and hemispheric asymmetry in the number of activated voxels in the functional regions appear to reflect the anatomic and physiological impact of the vascular malformation. Changes in fMRI findings after intervention reflect the consequences of therapy and parallel clinical recovery.

Key Words: cerebral arteriovenous malformation • magnetic resonance imaging • surgical treatment

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