Utility of pharmacologic provocative neurological testing before embolization of occipital lobe arteriovenous malformations.

摘要: Objective Endovascular treatment is an established option for of cerebral arteriovenous malformations (AVMs). However, embolization has been associated with postprocedural neurological complications. We sought to evaluate the usefulness intra-arterial pharmacologic provocative (superselective Wada) testing before occipital lobe AVMs. Methods performed a retrospective review cases AVMs that were embolized at our institution (Millard Fillmore Gates Hospital) while patient was under conscious sedation. Visual field and after superselective Wada again embolization. After microcatheterization target feeding pedicle, amobarbital (or, occasionally, methohexital) administered, followed immediately by testing. If test results negative, evaluated feeder liquid agent. Complications categorized as transient or permanent deficit, visual loss, ischemic hemorrhagic stroke, death. Results Thirteen patients underwent 39 tests 34 pedicles during 26 endovascular sessions. Patients treated sedation local anesthesia. The mean age these 43.5 years (range 16–62 years); 6 women. Testing induced deficit in six patients. A positive result led us abort attempts four pedicles. In two remaining cases, advancement catheter tip distally within pedicle allowed proceed initial failure. Neither developed Despite passing embolization, one other had detected few hours procedure; this lessened but permanent. No further complications no occurred. Conclusions Pharmacologic useful effective method determining safety AVM Our support performance procedures