Pharmacologic Provocative Testing in Combination With Intraoperative Neurophysiologic Monitoring During Arteriovenous Malformation Embolization

Tong, Xianzeng; Li, Xiaoyü; Ye, Ming; Hu, Peng; Li, Guilin; Zhang, Peng; Zhang, Hongqi; Zhuang, Ping

doi:10.1016/j.wneu.2021.06.104

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Several retrospective studies demonstrate that provocative pharmacologic testing along with intraoperative neurophysiologic monitoring have a high negative predictive value (55,60). Kothbauer et al reported that the sensitivity of muscle motor evoked potentials to detect motor deficit post-operatively was 100% and specificity 91% (61).…”

Section: Provocative Testingmentioning

confidence: 99%

Spinal tumor embolization: benefit for surgical resection

Maddy¹,

Trenchfield²,

Destine³

et al. 2023

BIJNN

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The embolization of hypervascular spinal tumors preoperatively has shown to be a worthwhile adjunctive procedure to minimize the elevated risks associated with surgical resection, such as intraoperative blood loss and its associated complications. Resection of these hypervascular tumors is necessary for local tumor control, reduction in patient-reported pain, improved neurological functioning, and spinal stability. This adjunctive procedure has been associated with improved surgical outcomes and easier facilitation of surgical resection. As such, we provide a review of the current literature examining the employment of this technique. Specifically, this article (a) reviews the techniques of embolization, with anatomical considerations of the arterial framework of the spinal network; (b) relativizes and outlines the post-embolization management of spinal tumor resection; (c) provides a critical outlook on the reported benefit of preoperative embolization before surgical resection with support from clinical studies in the literature; and (d) discusses the efficacy and reliability of provocative testing and post-procedural management and follow-up. Ultimately, a thorough and updated review of preoperative spinal tumor embolization and its clinical benefits will summarize the current fund of knowledge and encourage future research toward continued improvements in patient outcomes for those needing to undergo surgical resection of spinal lesions.

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Section: Provocative Testingmentioning

confidence: 99%

Spinal tumor embolization: benefit for surgical resection

Maddy¹,

Trenchfield²,

Destine³

et al. 2023

BIJNN

View full text Add to dashboard Cite

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Neurophysiological monitoring during endovascular treatment of brain arteriovenous malformations: A meta-analysis

et al. 2023

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Background Treatment of brain arteriovenous malformations (b-AVM) carries a risk of iatrogenic injury to eloquent brain regions. Intraoperative neuro-monitoring (IONM) has increasingly been used to monitor spontaneous or evoked neural activity during neurosurgery, but its use is not as well characterized in the endovascular treatment (EVT) of b-AVMs. We aimed to provide a systematic review and meta-analysis of studies reporting any neurological deficit after b-AVM embolization with IONM, with or without provocative test (PT), and no-IONM. Methods This systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from conception until March 1, 2022 for studies evaluating EVT with IONM and PT. Primary outcome was the rate of postoperative neurological deficits in EVT with IONM versus no-IONM, while secondary outcome was the subanalysis of IONM with or without PT. Meta-analysis was performed using the Mantel–Haenszel method and random effects modeling. Results Six studies reached synthesis. Out of a total of 192 EVT, 14 events occurred. Results demonstrated a nonsignificant trend favoring IONM compared to no-IONM to prevent neurological deficits (OR 0.09, 95% CI 0–4.68). Among the EVT with IONM, PT was done in 411 branches with 10 events (0.2%) despite a negative PT. There was a nonsignificant trend favoring IONM plus PT compared to IONM without PT (OR 0.16, 95% CI 0.02–1.07). Conclusions Our study suggests that b-AVM EVT with IONM plus PT might reduce rates of postprocedural neurological deficits compared with EVT without IONM. Further studies are needed to confirm these results.

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Pharmacologic Provocative Testing in Combination With Intraoperative Neurophysiologic Monitoring During Arteriovenous Malformation Embolization

Cited by 2 publications

References 14 publications

Spinal tumor embolization: benefit for surgical resection

Spinal tumor embolization: benefit for surgical resection

Neurophysiological monitoring during endovascular treatment of brain arteriovenous malformations: A meta-analysis

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