MethodsĪ multidisciplinary group was proposed by the Chinese Cerebrovascular Neurosurgery Society (CVNS) and Chinese Interventional & Hybrid Operation Society (IHOS) of Chinese Stroke Association (CSA) and confirmed by CSA Executive committee, including the clinical researchers on microsurgery, endovascular neurosurgery, stereotactic radiosurgery, neuroradiology, and functional neuroimaging. The purpose of this guideline is to review current studies and develop recommendations for the management of bAVMs with eloquent areas involved. Challenges exist in preoperative assessments of neurological function, prediction of operative risks, and decision-making of therapeutic strategy and method. Several links remain unclear in the management of bAVMs, especially in those located in eloquent areas. However, the risk of suboptimal outcomes must be carefully balanced between treatments and wait-and-see strategies. Current treatments, such as microsurgical resection, stereotactic radiotherapy (SRS), endovascular embolization, and multimodality treatments mainly aim at preventing hemorrhagic stroke ( 3). Brain AVMs may lead to spontaneous intracranial hemorrhage (ICH), seizures, neurological deficits, or headaches, usually in young people ( 1, 2).

With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.īrain arteriovenous malformations (bAVMs) are an abnormal collection of blood vessels wherein arterial blood flows directly into draining veins without the normal interposed capillary beds, while no brain parenchyma is contained within the nidus. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III.Ĭonclusions: The management of eloquent bAVMs remains challenging. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved.

Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association.

Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. 9Savaid Medical School, University of Chinese Academy of Sciences, Beijing, ChinaĪim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas.8Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Army Characteristic Medical Center, Beijing, China.7Gamma Knife Center, Beijing Neurosurgical Institute, Beijing, China.6Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.5Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.4Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.3Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.2China National Clinical Research Center for Neurological Diseases, Beijing, China.1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.Mingze Wang 1,2,3,4 † Yuming Jiao 1,2,3,4 † Chaofan Zeng 1,2,3,4 Chaoqi Zhang 1,2,3,4 Qiheng He 1,2,3,4 Yi Yang 1,2,3,4 Wenjun Tu 1,2,3,4 Hancheng Qiu 1,2,3,4 Huaizhang Shi 5 Dong Zhang 1,2,3,4 Dezhi Kang 6 Shuo Wang 1,2,3,4 A-li Liu 1,2,3,4,7 * Weijian Jiang 8 * Yong Cao 1,2,3,4 * Jizong Zhao 1,2,3,4,9 on behalf of Chinese Cerebrovascular Neurosurgery Society Chinese Interventional & Hybrid Operation Society of Chinese Stroke Association

Non eloquent brain areas