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Updated: Aug 27, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Superselective Anesthesia Functional Examination of the Diaphragm during Endovascular Embolization of Spinal Cord
Suparna Bharadwaj1, Radhakrishnan Muthuchellappan1
1Department of Neuroanaesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Abstract:
Superselective anesthesia functional evaluation (SAFE) is an adjunct to the Wada test. It is performed to rule out unintentional positioning of the tip of the embolization catheter proximal to the origin of a normal artery supplying eloquent region of spinal cord. We report a case of a 36-year-old male with cervical intramedullary spinal cord arteriovenous malformation (SCAVM) at C3 level. In this patient, we monitored motor-evoked potentials (MEPs) of bilateral upper and lower limbs along with diaphragm. Electrodes for compound muscle action potential of diaphragm were placed under fluoroscopy guidance. Through this case, we want to emphasize that intraprocedural diaphragmatic MEPs enhance the safety margin during endovascular embolization of cervical intramedullary SCAVMs. Placement of electrodes under fluoroscopy guidance ensures proper positioning into the diaphragm muscle.
