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Updated: Jun 10, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Provocative Testing for Embolization of Spinal Cord AVMs
1The Center for Endovascular Surgery and Division of Intraoperative Neurophysiology, Hyman Newman Institute for Neurology and Neurosurgery, Beth Israel Medical Center Singer Division; New York, NY - USA.
Chemical provocative testing with sodium amytal and lidocaine, alongside neurophysiological monitoring of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs), effectively predicts safe embolization of spinal cord arteriovenous malformations (SCAVMs). This combined approach ensures procedural safety by preventing embolization when neurophysiological changes occur.
Area of Science:
- Neurology
- Interventional Radiology
- Neurophysiology
Background:
- Spinal cord arteriovenous malformations (SCAVMs) pose significant risks during embolization.
- Accurate assessment of arterial supply and potential neurological compromise is crucial before intervention.
Purpose of the Study:
- To evaluate the efficacy and reliability of chemical provocative testing using neurophysiological monitoring before spinal cord AVM embolization.
- To determine if sodium amytal and lidocaine injections can predict neurological deficits during embolization procedures.
Main Methods:
- Retrospective analysis of 41 procedures in 26 patients with SCAVMs.
- Superselective injection of sodium amytal (50mg) and lidocaine (40mg) with monitoring of cortical somatosensory evoked potentials (SEPs) and trans-cranial motor evoked potentials (MEPs).
- Embolization with NBCA was withheld if any change in SEPs or MEPs occurred post-injection.
Main Results:
- No false negative results were observed in provocative testing.
- Sodium amytal testing was positive in one case (loss of MEPs).
- Lidocaine testing was positive in 10 cases, affecting MEPs and/or SEPs in various spinal arteries.
- Neither agent caused loss of both SEPs and MEPs simultaneously.
Conclusions:
- Sodium amytal and lidocaine are complementary pharmacological agents for provocative testing.
- SEPs and MEPs are complementary neurophysiological monitoring methods.
- Combined use of both agents and both monitoring methods is recommended for safe SCAVM embolization.
