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.Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.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 * and Jizong Zhao 1,2,3,4,9 on behalf of Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society of Chinese Stroke Association Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative.
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