POSTOPERATIVE COGNITIVE AND SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY ASSESSMENT OF PATIENTS WITH RESECTION OF PERIOPERATIVE HIGH-RISK ARTERIOVENOUS-MALFORMATIONS

WE STUDIED THE outcome of in patients who had undergone high-risk surg ery for an arteriovenous malformation at our institution between Novem ber 1991 and November 1993. All of the lesions were located in the dom inant (left) hemisphere. Perioperative risk was assessed by the locati on of the lesion in functionally eloquent cortex (seven patients) or d eep structures (two patients) or the lesion's large volume (two patien ts). Our patients included six women and four men, and their ages rang ed from 22 to 53 years (mean, 35.8). Our follow-up study included the evaluation of neurological sequelae but mainly emphasized the study of cognitive deficits (seven major functional clusters), the incidence o f depression and behavioral changes, and the assessment of regional ce rebral blood flow with single photon emission computed tomography. Six patients returned to a seemingly ''normal'' daily life with some mino r deficits postoperatively, three developed contralateral hemiparesis, and one had disabling cognitive deficits. Our comprehensive cognitive assessment, in particular, showed that although patients might appear ''normal'' on a routine neurological examination, most patients showe d a mild deficit in at least one cognitive function and three were sev erely impaired. In addition, the single photon emission computed tomog raphic studies pointed out hypoperfusion in more extensive regions tha n the surgical defects shown by magnetic resonance imaging or computed tomographic studies. These single photon emission computed tomography images helped to explain some of the cognitive and behavioral changes better than the anatomic studies. This information will make it possi ble for the physician to offer continuing supportive care for the pati ent in postoperative transition to normal life activities.