Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization

Lauren R. Moo, Kieran J. Murphy, Philippe Gailloud, Mark Tesoro, John Hart

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: Although results with 27 of 29 provocative amobarbital injections were negative, results with two injections in two different individuals revealed cognitive deficits during tailored provocative testing. In both, the evoked deficits resolved with dissipation of the amobarbital effect; the feeder vessels were not embolized. Neurologic and cognitive evaluation after each of 27 embolizations revealed no major or minor deficits. CONCLUSION: In our experience, provocative amobarbital testing prior to AVM embolization was helpful in identifying vascular territories where embolization may lead to neurologic and cognitive deficits.

Original languageEnglish (US)
Pages (from-to)416-421
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume23
Issue number3
StatePublished - 2002
Externally publishedYes

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Amobarbital
Arteriovenous Malformations
Nervous System
Injections
Neurologic Manifestations
Enbucrilate
Intracranial Arteriovenous Malformations
Fluoroscopy
Adhesives
Blood Vessels
Incidence
Brain

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization. / Moo, Lauren R.; Murphy, Kieran J.; Gailloud, Philippe; Tesoro, Mark; Hart, John.

In: American Journal of Neuroradiology, Vol. 23, No. 3, 2002, p. 416-421.

Research output: Contribution to journalArticle

Moo, Lauren R. ; Murphy, Kieran J. ; Gailloud, Philippe ; Tesoro, Mark ; Hart, John. / Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization. In: American Journal of Neuroradiology. 2002 ; Vol. 23, No. 3. pp. 416-421.
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