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Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization

Published:February 24, 2018DOI:https://doi.org/10.1016/j.clinimag.2018.02.014

      Abstract

      A middle-aged patient underwent staged endovascular embolization of a Spetzler-Martin grade V right parietal arteriovenous malformation(AVM).In the fifth endovascular embolization, after methohexital 10 mg injection into a right posterior choroidal artery feeding the AVM nidus, there was an immediate change in the electroencephalogram (EEG) with simultaneous loss of motor evoked potentials (MEPs) in the bilateral upper and lower extremities and a delayed change in somatosensory evoked potential responses (SSEPs). No embolization was made and procedure was terminated. This case demonstrates the utility of intraoperative neurophysiologic monitoring (IONM) with pharmacologic provocative testing in predicting and mitigating the risks prior to the proposed embolization.

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      References

        • Feliciano C.E.
        • de Leon-Berra R.
        • Hernandez-Gaitan M.S.
        • Torres H.M.
        • Creagh O.
        Provocative test with propofol: experience in patients with cerebral arteriovenous malformations who underwent neuroendovascular procedures.
        31(3). 2010: 470-475
        • Sala F.
        • Beltramello A.
        • Gerosa M.
        Neuroprotective role of neurophysiological monitoring during endovascular procedures in the brain and spinal cord.
        Neurophysiol Clin. 2007; 37: 415-421
        • Buchtel H.A.
        • Passaro E.A.
        • Selwa L.M.
        • Deveikis J.
        • Gomez-Hassan D.
        Sodium methohexital (brevital) as an anesthetic in the Wada test.
        Epilepsia. 2002; 43: 1056-1061
        • Andelman F.
        • Kipervasser S.
        • Reider II, G.
        • Fried I.
        • Neufeld M.Y.
        Hippocampal memory function as reflected by the intracarotid sodium methohexital Wada test.
        Epilepsy Behav. 2006; 9: 579-586
        • Loddenkemper T.
        • Moddel G.
        • Dinner D.S.
        • Kim H.
        • Schuele S.U.
        • Alexopoulos A.V.
        • et al.
        Language assessment in Wada test: comparison of methohexital and amobarbital.
        Seizure. 2009; 18: 656-659
        • Peters K.R.
        • Quisling R.G.
        • Gilmore R.
        • Mickle P.
        • Kuperus J.H.
        Intraarterial use of sodium methohexital for provocative testing during brain embolotherapy.
        AJNR Am J Neuroradiol. 1993; 14: 171-174
        • Li F.
        • Deshaies E.
        • Allott G.
        • Gorji R.
        Transcranial motor evoked potential changes induced by provocative testing during embolization of cerebral arteriovenous malformations in patients under total intravenous anesthesia.
        Am J Electroneurodiagnostic Technol. 2011; 51: 264-273