Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization

Clin Imaging. 2018 Sep-Oct:51:155-159. doi: 10.1016/j.clinimag.2018.02.014. Epub 2018 Feb 25.

Abstract

A middle-aged patient underwent staged endovascular embolization of a Spetzler-Martin grade V right parietal arteriovenous malformation(AVM).In the fifth endovascular embolization, after methohexital 10 mg injection into a right posterior choroidal artery feeding the AVM nidus, there was an immediate change in the electroencephalogram (EEG) with simultaneous loss of motor evoked potentials (MEPs) in the bilateral upper and lower extremities and a delayed change in somatosensory evoked potential responses (SSEPs). No embolization was made and procedure was terminated. This case demonstrates the utility of intraoperative neurophysiologic monitoring (IONM) with pharmacologic provocative testing in predicting and mitigating the risks prior to the proposed embolization.

Keywords: Arteriovenous malformation; Endovascular embolization; Intraoperative neuromonitoring; Methohexital; Pharmacologic provocative testing.

Publication types

  • Case Reports

MeSH terms

  • Anesthetics, Intravenous* / pharmacology
  • Arteriovenous Fistula* / physiopathology
  • Brain
  • Electroencephalography
  • Embolization, Therapeutic / methods*
  • Evoked Potentials, Motor
  • Evoked Potentials, Somatosensory
  • Humans
  • Intracranial Arteriovenous Malformations / physiopathology
  • Intracranial Arteriovenous Malformations / therapy*
  • Intraoperative Neurophysiological Monitoring / methods
  • Methohexital* / pharmacology
  • Middle Aged
  • Posterior Cerebral Artery / abnormalities*

Substances

  • Anesthetics, Intravenous
  • Methohexital