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Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization.
Lauren R Moo1, Kieran J Murphy, Philippe Gailloud
1Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
AJNR. American Journal of Neuroradiology
|March 20, 2002
Summary
Provocative amobarbital testing before cerebral arteriovenous malformation (AVM) embolization helps identify risks. This targeted neurologic and cognitive assessment prevented embolization in two patients, avoiding potential deficits.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Cerebral arteriovenous malformations (AVMs) pose a risk of neurologic complications (7-39%) after transarterial embolization.
- Current embolization techniques lack methods to predict or prevent focal neurologic and cognitive deficits.
Observation:
- A tailored neurologic and cognitive testing battery was developed for 12 patients undergoing AVM embolization.
- Superselective amobarbital injection into feeder vessels preceded targeted testing to assess potential deficits.
Findings:
- Two of 29 amobarbital tests revealed temporary cognitive deficits, prompting the decision not to embolize those specific feeder vessels.
- The remaining 27 embolizations proceeded without any major or minor postprocedural neurologic or cognitive deficits.
Implications:
- Provocative amobarbital testing is a valuable tool for identifying high-risk vascular territories before AVM embolization.
- This method can proactively prevent iatrogenic neurologic and cognitive deficits, improving patient safety during AVM treatment.