PMID: 11901011Mar 20, 2002Paper

Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization.

AJNR. American Journal of Neuroradiology
Lauren R MooJohn Hart

Abstract

Transarterial embolization of cerebral arteriovenous malformations (AVMs) has been associated with postprocedural neurologic complications in 7-39% of patients. We sought to determine whether a method of targeted neurologic and cognitive testing during AVM embolization reduces the incidence of focal cognitive and other neurologic deficits associated with the procedure. A cognitive neurologist extensively examined 12 patients prior to AVM embolization. In each patient, a battery of tests tailored to their specific abilities was developed by using stimuli selected from standard and experimental cognitive tests to probe specific brain regions related to the location of the AVM. In each feeder vessel to be embolized, a 50-mg bolus of sodium amobarbital was superselectively administered through a microcatheter; this was followed immediately by neurologic and cognitive testing with the tailored battery. After testing, the position of the microcatheter tip was checked with fluoroscopy. If the provocative test results were negative, the evaluated feeder was embolized with N-butyl cyanoacrylate glue. Although results with 27 of 29 provocative amobarbital injections were negative, results with two injections in two different individuals ...Continue Reading

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