title: Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature.
abstract: OBJECTIVE
  Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature.
  
  
  METHODS
  In accordance with the Henry Ford Institutional Review Board, medical records of patients with sAVMs treated from 2000 to 2012 were reviewed. Clinical data were retrospectively collected to calculate pre- and posttreatment modified Rankin Scale scores for all patients.
  
  
  RESULTS
  The authors identified 15 patients with sAVMs who received treatment. Of these, 12 were female and 3 were male, and the average age at presentation was 39.6 ± 12.94 years (± SD). Two patients (13.3%) had Spetzler-Martin Grade I lesions, 6 patients (40%) had Grade II lesions, 5 patients (33.3%) had Grade III lesions, and another 2 (13.3%) harbored Grade IV arteriovenous malformations (AVMs). According to the Sugita classification, 6 patients (40%) had medial lesions, 6 (40%) had lateral lesions, 2 (13.3%) had deep lesions, and 1 patient (6.67%) had a pure sAVM. Eight patients (53.3%) underwent stereotactic radiosurgery while 7 patients (46.7%) had microsurgical resection; 1 patient underwent surgical extirpation after incomplete response following radiosurgery. After treatment, 9 patients were unchanged from pretreatment (60%), 3 patients worsened, and 2 patients had improved functional outcome (20% and 13.3%, respectively). The authors' literature search yielded 348 patients with sAVMs, most of them harboring Spetzler-Martin Grade II and III lesions. Approximately 98% of the patients underwent resection with excellent outcomes.
  
  
  CONCLUSIONS
  While the ideal choice of therapeutic modality for cerebral AVMs remains controversial in light of the recent publication of the ARUBA (A Randomized trial of Unruptured Brain AVMs) trial, a multidisciplinary treatment approach for the management of sAVMs can lead to acceptable neurological outcome.
authors.affiliation: Departments of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Aqueel H
authors.initials: AH
authors.lastname: Pabaney
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Reinard
authors.forename: Lara W
authors.initials: LW
authors.lastname: Massie
authors.forename: Padmaja K
authors.initials: PK
authors.lastname: Naidu
authors.forename: Yedathore S
authors.initials: YS
authors.lastname: Mohan
authors.forename: Horia
authors.initials: H
authors.lastname: Marin
authors.forename: Ghaus M
authors.initials: GM
authors.lastname: Malik
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology*; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D039781:PubMed / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACA = anterior cerebral artery; AVM = arteriovenous malformation; ICA = internal carotid artery; KPS = Karnofsky Performance Scale; MCA = middle cerebral artery; PCA = posterior cerebral artery; SRS = stereotactic radiosurgery; arteriovenous malformation; insular cortex; mRS = modified Rankin Scale; sAVM = sylvian AVM; sylvian fissure