Diagnostic cerebral angiography and the Wada test in pediatric patients

Pediatric cerebral angiography is a commonly performed procedure and its performance has many similarities to the technique used in adults. However, some notable differences exist, especially in the nuances of arterial access, catheter manipulation, patient sedation, and fluid/radiocontrast load. A thorough understanding of cerebral angiography and its application to pediatric patients is imperative to ensure appropriate selection of patients requiring cerebral angiography and to minimize risk while obtaining the desired information. The intracarotid sodium Amytal injection (Wada) test is a specialized procedure performed in the workup of patients with seizure disorders who are being considered for surgical resective therapy. However, Wada testing in children poses unique challenges, as will be discussed in this paper. Specific aspects of performing the Wada test in the pediatric setting, anatomic considerations and contraindications, and the relevance of the Wada test in comparison with noninvasive tools, such as functional magnetic resonance imaging, will be discussed.