Abstract
Development of microsurgical techniques has made neurosurgical operation safe and accurate. However operation on AVMs on the motor cortex is still controversial because of postoperative neurological deficit. One milimater of brain around the AVM was reported to be nonfunctional. Two out of patients with AVMs on the motor cortex were operated on under MEP (motorevoked potential) monitoring. Case 1: A 37 year old male was admitted with convulsions. CT and angiogram showed a moderately large AVM on the left motor cortex. Surgical excision was scheduled under MEP monitoring. The AVM was just on the motor cortex. MEP was taken from the gyrus below the AVM. The AVM was nicely removed without bleeding or extra brain damage. The threshold of MEP was the same or slightly better after removal of the AVM. Post-operatively, the patient developed hemiparesis, especially in the legs, which recovered 2 months after the operation. Case 2: A 22 year old female was admitted with convulsions. CT and angiogram showed on AVM on the right motor cortex. Surgical excision was done following a chart which was drawn from the angiogram. Post-operatively, the patient developed left hand palsy, which recovered a month after the operation. These operative techniques and course of recovering post-operative neurological deficit were reported.
