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

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.