Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures

Feliciano, Caleb; León-Berra, Ramón de; Hernández-Gaitán, Manuel S.; Torres, Hernando; Creagh, Osmar; Rodríguez‐Mercado, Rafael

doi:10.3174/ajnr.a1855

Cited by 24 publications

(12 citation statements)

References 14 publications

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“…Mikati et al 23 consider that as indicated by other authors 21,22,24,25 , propofol is a reasonable alternative to the use of amobarbital as an anesthetic to perform the Wada test. Feliciano et al 28 found no adverse effects of the superselective test with a 7 mg propofol dose. the absence of adverse effects in our series, despite the use of 20 mg doses, higher than those reported in the literature, even with reinjection during the same embolization session, can be explained by the superselective administration, which prevents the peripheral cholinergic effects of propofol occurring in intra-carotid administration.…”

Section: Discussionmentioning

confidence: 95%

“…It has only a few adverse effects causing a transient deficit of neurological functions. there are a small number of reports on the use of propofol to perform the superselective test 27,28 . this study deals with the efficacy and safety of the superselective test with propofol for determining eloquent areas in the treatment of brain arteriovenous malformations.…”

Section: Resultsmentioning

confidence: 99%

“…however, the incidence of adverse effects has not been described and an inadequate product supply has been reported. Some studies provide information on the use of propofol in performing the Wada test [21][22][23][24][25][26] and, recently, in performing the superselective Wada test, with results similar to those of amobarbital 27,28 . Propofol is a non-toxic anesthetic for the vascular endothelium 34 that crosses the blood-brain barrier and acts on the central nervous system (cNS).…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of the Superselective Test with Propofol for Determining Eloquent Brain Regions in the Endovascular Treatment of Arteriovenous Malformations

González¹,

Guerra²,

López

et al. 2013

Interv Neuroradiol

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The superselective test for determining eloquent brain areas, carried out prior to the embolization treatment for arteriovenous malformations (AVMs), is a tool contributing to increase the safety of endovascular procedures. Taking into account amobarbital unavailability, it was decided to carry out the present study to demonstrate the efficacy and safety of propofol as an alternative to amobarbital to perform this test. A group of 58 patients were treated in 91 embolization sessions for brain AVMs using endovascular surgery between February 2006 and February 2011. The superselective test was performed prior to embolization with Histoacryl, using the intra-arterial administration of 20 mg propofol through a microcatheter positioned near the AVM nidus. Ten (7.8%) of the 128 superselective tests were positive. Neurological deficits appeared immediately after propofol administration, lasted for one minute and disappeared after five minutes. Only one of the patients showing a negative test result developed neurological deficits after embolization, for 99.2% negative predictive vale. Despite their positive test results, six patients were embolized and five developed post-embolization neurological deficits, for 83.3% positive predictive value. The test showed 83.3% sensitivity and 99.2% specificity. The use of propofol to perform the superselective test during brain AVM embolization is a safe and effective alternative to amobarbital, and may predict the occurrence of post-embolization ischemic complications.

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Section: Discussionmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility of the Superselective Test with Propofol for Determining Eloquent Brain Regions in the Endovascular Treatment of Arteriovenous Malformations

González¹,

Guerra²,

López

et al. 2013

Interv Neuroradiol

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“…The provocative tests with local anesthetics (propofol, etomidate, barbiturates etc.,) are essential before sacrificing the parent artery to predict the successful treatment with endovascular therapy, without neurological deficits. [14] However, in our case, balloon occlusion test using Hyperglide balloon 4 mm × 10 mm for 5 min was done as the lesion was located in the noneloquent area. Onyx 18 becomes solidified when it comes in contact with water or blood.…”

Section: Discussionmentioning

confidence: 99%

Onyx embolization of distal middle cerebral artery aneurysm in a patient with nontraumatic subdural hematoma

2019

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Distal cortical middle cerebral artery (MCA) aneurysm is a rare entity. Despite the challenging procedure, the role of endovascular treatment is emerging due to its safety and efficacy in obliterating the microaneurysm. We report a 25-year-old male, who presented with a history of dizziness and headache for almost 2 weeks. Computed tomography scan showed a right front parietal subdural hematoma (SDH). We could not identify any underlying defining etiology of SDH neither head injury nor coagulopathy disorder. Therefore, diagnostic cerebral angiogram was performed, which showed a microaneurysm in the distal right MCA cortical branch. Hence, complete obliteration of this microaneurysm was performed using Onyx for endovascular embolization. Therefore, this case report demonstrates the efficacy of this modality in the treatment of microaneurysms with SDH.

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“…Rauch et al [35] used SEP monitoring during the endovascular treatment of brain AVMs in awake patients, whereas Sala et al [10] employed both SEPs and MEPs in patients under general anesthesia. Other studies performed PTs without any kind of neurophysiological tests in awake patients [36,37]. …”

Section: Discussionmentioning

confidence: 99%

Implementation of Intraoperative Neurophysiological Monitoring during Endovascular Procedures in the Central Nervous System

et al. 2014

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Background and Objective: Intraoperative monitoring (IOM) has been used in different surgical disciplines since the 1980s. Nonetheless, regular routine use of IOM in interventional neuroradiology units has only been reported in a few centers. The aim of this study is to report our experience, 1 year after deciding to implement standardized IOM during endovascular treatment of vascular abnormalities of the central nervous system. Methods: Basic recordings included somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs). Corticobulbar motor-evoked potentials and flash-visual-evoked potentials were also recorded depending on the topography of the lesion. Intra-arterial provocative tests (PTs) with amobarbital and lidocaine were also performed. All patients except 1 were under total intravenous anesthesia. Clinical outcome was assessed prospectively and correlated with IOM events. Results: Twelve patients and 15 procedures were monitored during the inclusion period. Significant IOM events were detected during 3 of the 15 procedures (20%). We observed temporary MEP changes in 2 cases which resolved after interruption of the embolization or application of corrective measures, leaving no postoperative neurological deficits. In 1 case, persistent SEP and MEP deterioration was detected secondary to a frontal hematoma, resulting in mild sensory-motor deficit in the right upper extremity after the procedure. Overall, 12 PTs (4 spinal cord and 8 brain abnormalities) were performed using lidocaine and sodium amytal injections. One positive result occurred after the injection of lidocaine. No false negatives were detected. Conclusions: IOM may provide continuous real-time data about the functional status of eloquent areas and pathways of the central nervous system in patients under general anesthesia. It therefore allows us to detect early neurological damage in time to perform specific actions that may prevent irreversible neurological deficits.

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Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures

Cited by 24 publications

References 14 publications

Feasibility of the Superselective Test with Propofol for Determining Eloquent Brain Regions in the Endovascular Treatment of Arteriovenous Malformations

Feasibility of the Superselective Test with Propofol for Determining Eloquent Brain Regions in the Endovascular Treatment of Arteriovenous Malformations

Onyx embolization of distal middle cerebral artery aneurysm in a patient with nontraumatic subdural hematoma

Implementation of Intraoperative Neurophysiological Monitoring during Endovascular Procedures in the Central Nervous System

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