Modification de l’index bispectral suite à une embolisation avec alcool absolu chez un patient souffrant de malformation artérioveineuse intracrânienne

Abstract

Purpose:We report a case of bispectral index (BIS) falling to zero during absolute alcohol embolization of an intracranial arteriovenous malformation (AVM) under anesthesia. This case highlights the unusual effect of a therapeutic dose of parenteral alcohol on the central nervous system using BIS monitoring. Clinical features:A 29-yr-old male with a left parieto-occipital arteriovenous malformation underwent neuroendovascular embolization under general anesthesia. During injection of absolute alcohol injection into the AVM nidus, the patient developed hypertension and tachycardia coincident with a profound and sustained reduction of BIS values to zero, despite a stable level of anesthesia. Immediate angiography revealed no evidence of hemorrhage or new changes in the patient's cerebral vasculature. Post-procedure, the patient remained drowsy for several hours with signs of alcohol intoxication. He had full neurological recovery. Conclusions:In the presence of normal cerebral angiographic findings, suppression of BIS values may serve as an early indicator of CNS responses to intracranial injection of absolute alcohol for embolization of an arteriovenous malformation.

Case study: Systemic complications following absolute alcohol embolisation of scalp arteriovenous malformation

“…Ethanol is usually injected with some form of ow arrest to limit egress from the malformation due to its propensity to cause various side effects after systemic absorption. [4][5][6][7][8][9] Yakes et al reported a complication rate of 10-30% related to alcohol. 10 The dose of ethanol used for ablation is the sole determinant of occurrence of these complications.…”

Bispectral index detects intraoperative cerebral ischaemia during balloon assisted cerebral aneurysm coiling

“…These include rupture of cerebral aneurysms during coiling 1 , embolization of arterio-venous malformations 2 and intraventricular haemorrhage during third ventriculoscopy 3 . Rapid increases in intracranial pressure and vasospasm have been postulated as possible causes for the decrease in BIS values.…”

Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage via Interventional Embolization of Middle Meningeal Artery

“…This procedure was followed by external carotid arterial angiography, placing an Excelsior ® SL-10 microcatheter (Target Therapeutics/Boston Scientific, Fremont, CA, USA) under fluoroscopic guidance and placing a Traxcess ® 14 microguidewire (MicroVention, Tustin, CA, USA) into the trunk of middle meningeal artery followed by slow injection of absolute alcohol through the microcatheter for embolization ( 23 , 24 ). Based on previous reports and our experience using absolute alcohol in our institution ( 25 , 26 ), we mixed alcohol and contrast agent in an 8:2 ratios and used a dose of 0.03 ml/kg mixture for embolization, which we injected slowly. After injection, we removed the syringe and evaluated the extent of embolization.…”