MRI Quicktome Aided Resection of Pediatric Arteriovenous Malformations

Introduction: Quicktome is an MRI-based platform that integrates connectomic data to visualize structural and functional connections within the brain. While individualized brain maps based on diffusion tensor imaging have been applied in cases of tumor resection and adult AVM resection, its application to pediatric arteriovenous malformation (AVM) has not yet been reported.

Methods: We report our early experience with the Quicktome platform in guiding pediatric AVM resection in two patients. A brain map generated by Quicktome software, which uses diffusion tensor imaging input along with machine learning techniques, was overlaid on standard T1 anatomic MR sequences displayed on an intraoperative navigation system. Imaging and operative approach were analyzed. The neurological status of the patient was followed for a minimum of six months after surgery.

Results: A 9-year-old female presented with acute atraumatic headache and right upper and lower extremity hemiplegia. Head CT revealed a left frontoparietal intraparenchymal hemorrhage, and CT angiogram (CTA) showed an AVM nidus. The superior parietal lobule approach was selected based on the location of the corticospinal tract in relation to the AVM nidus, as demonstrated by Quicktome software. The AVM was fully resected and the patient recovered full motor function.

A 10-year-old male presented with sudden onset of vomiting and lethargy. Head CT showed intraventricular hemorrhage, and CTA revealed a left parietal AVM abutting the left lateral ventricle. Quicktome was used due the proximity of the nidus to the left optic radiations and somatosensory cortex. The superior parietal lobule approach was used, and the AVM was fully resected. The patient remained neurologically intact.

Conclusion : Quicktome software may be applied to pediatric cerebral AVM resection to guide surgical approach and resection for pediatric AVMs in close proximity to the corticospinal tract and optic radiations. Future studies may correlate pre- and post-operative Quicktome data with neurologic function.