Intraoperative Neuromonitoring during Peripheral Arteriovenous Malformation Embolization

Area of Science:

• Interventional Radiology
• Neurology
• Vascular Surgery

Background:

• Peripheral arteriovenous malformations (AVMs) pose a risk of nerve injury during embolization.
• Intraoperative neuromonitoring (IONM) is used to detect potential nerve damage during procedures.

Purpose of the Study:

• To assess if IONM, including a lidocaine injection challenge (provocative testing), reduces irreversible nerve injury risk during peripheral AVM embolization.

Main Methods:

• Retrospective review of 17 patients undergoing 59 embolization procedures with IONM and provocative testing (2012-2021).
• Data included patient demographics, AVM characteristics, embolic agents, IONM signals, and outcomes.
• Procedural decisions were guided by IONM findings after lidocaine challenge and during embolization.

Main Results:

• No permanent neurologic deficits were observed in the cohort.
• Transient deficits (numbness, weakness) occurred in 3 patients (4 sessions) but resolved by postoperative day 4.
• IONM data was adequate for 59 procedures in 17 patients.

Conclusions:

• IONM with provocative testing during AVM embolization appears to minimize the risk of nerve injury.
• This combined approach may enhance patient safety during embolotherapy for peripheral AVMs.