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Correlates of Arterial-Filling Patterns in the Intracarotid Amobarbital Procedure

Correlates of Arterial-Filling Patterns in the Intracarotid Amobarbital Procedure Abstract Objective: To determine behavioral correlates of anterior cerebral artery (ACA) and posterior cerebral artery (PCA) perfusion patterns in the intracarotid amobarbital sodium procedure. Design: Multivariate analysis of covariance and partial correlations of behavioral measures to ACA crossflow and PCA filling. Setting: Angiography and the intracarotid amobarbital procedure at a comprehensive epilepsy center. Subjects: Forty-two patients with intractable epilepsy (right-hemisphere seizure focus [n-23]; left-hemisphere seizure focus [n=19]). Measurements: Internal carotid angiography was performed both at a standard injection rate (8 mL of contrast per second) and at 1 mL/s, which matched the rate of the subsequent amobarbital injection. The degree of ipsilateral PCA and contralateral ACA filling were graded on a seven-point scale and compared with postinjection behavior, language, and memory measures. Results: The ACA crossflow did not correlate significantly with that of any measure. The degree of PCA-filling pattern correlated significantly only with the level of consciousness (r=.31, P<.004), but it was not significant after accounting for the effects of seizure laterality, injection side, and amobarbital dosage. Neither ACA crossflow nor PCA filling correlated significantly with memory. The degree of ACA and PCA filling was overestimated at standard angiography (8 mL of contrast medium per second) injection rates. Conclusions: Although the degree of PCA filling correlates mildly with the level of consciousness postinjection, possibly by perfusion of thalamic or mesencephalic branches, it is not reliably predictive and is less contributory than the injection side and seizure laterality. The PCA filling is not required to produce valid memory assessment in the intracarotid amobarbital procedure, and ACA crossflow is not predictive of behavioral responses. References 1. Branch C, Milner B, Rasmussen T. Intracarotid sodium amytal for the lateralization of cerebral speech dominance . J Neurosurg . 1964;21:399-405.Crossref 2. Jones-Gotman M. Psychological evaluation—testing hippocampal function . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987:203-211. 3. Loring D, Meador K, Lee G, King D. Amobarbital Effects and Lateralized Brain Function . New York, NY: Springer-Verlag NY Inc; 1992. 4. Rausch R, Risinger M. Intracarotid sodium amobarbital procedure . Neuromethods . 1990;15:127-146. 5. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for lateralization of cerebral speech dominance: experimental and clinical observations . J Neurosurg . 1960;17:266-282.Crossref 6. Lesser RP, Dinner DS, Luders H, Morris HH. Memory for objects presented soon after intracarotid amobarbital sodium injections in patients with medically intractable complex partial seizures . Neurology . 1986;36:895-899.Crossref 7. Carpenter M, Sutin J. Human Neuroanatomy . 8th ed. Baltimore, Md: Williams & Wilkins; 1983. 8. Milner B, Branch C, Rasmussen T. Study of short-term memory and intracarotid injection of sodium amytal . Trans Am Neurol Assoc . 1962;87:224-226. 9. Milner B. Psychological aspects of focal epilepsy and its neurosurgical management . Adv Neurol . 1975;8:299-321. 10. Rausch R, Babb TL, Engel J, Crandall PH. Memory following intracarotid amobarbital injection contralateral to hippocampal damage . Arch Neurol . 1989:46: 783-788.Crossref 11. Gotman J, Bouwer M, Jones-Gotman M. Intracranial EEG study of brain structres affected by internal carotid injection of amobarbital . Neurology . 1992; 42:2136-2143.Crossref 12. DeToledo J, Smith D, Kramer R. A proposed cause for the variability of memory lateralization in amytal suppression (Wada) testing: role of the septal region . Epilepsia . 1989;30:712. 13. Jeffery PJ, Monsein LH, Szabo Z, et al. Mapping the distribution of amobarbital sodium in the intracarotid Wada test by use of Tc-99m HMPAO with SPECT . Radiology . 1991;178:847-850.Crossref 14. Perrine K, Gershengorn J, Brown E, Choi I, Luciano D, Devinsky O. Materialspecific memory in the intracarotid amobarbital procedure . Neurology . 1993; 43:706-711.Crossref 15. Christianson S, Saisa J, Silfvenius H. Hemisphere memory differences in sodium amytal testing of epileptic patients . J Clin Exp Neuropsychol . 1990;12: 681-694.Crossref 16. Engel J Jr, Rausch R, Lieb JP, Kuhl DE, Crandall PH. Correlation of criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy . Ann Neurol . 1981;9:215-224.Crossref 17. Fedio P, Weinberg LK. Dysnomia and impairment of verbal memory following intracarotid injection of sodium amytal . Brain Res . 1971;31:159-168.Crossref 18. Loring DW, Lee GP, Meador KJ, et al. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomy . Neurology . 1990;40:605-610.Crossref 19. Milner B. Disorders of learning and memory after temporal lobe lesions in man . Clin Neurosurg . 1972;19:421-446. 20. Powell GE, Polkey CE, Canavan AGM. Lateralisation of memory functions in epileptic patients by use of the sodium amytal (Wada) technique . J Neurol Neurosurg Psychiatry . 1987;50:665-672.Crossref 21. Rausch R, Fedio P, Ary CM, Engel J Jr, Crandall PH. Resumption of behavior following intracarotid sodium amobarbital injection . Ann Neurol . 1984;15:31-35.Crossref 22. Sass KJ, Lencz T, Westerveld M, Novelly RA, Spencer DD, Kim JH. The neural substrate of memory impairment demonstrated by the intracarotid amobarbital procedure . Arch Neurol . 1991;48:48-52.Crossref 23. Walker JA, Stanulis RG, Laxer KD. What stages of memory do the temporal lobes serve? a sodium amytal perspective . In: Engel J Jr, Ojemann GA, Luders HO, Williamson PD, eds. Fundamental Mechanisms of Human Brain Function . New York, NY: Raven Press; 1987:111-116. 24. Wyllie E, Naugle R, Chelune G, Luders H, Morris HH, Skibinski C. Intracarotid amobarbital procedure, II: lateralizing value in evaluation for temporal lobectomy . Epilepsia . 1991;32:865-869.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Correlates of Arterial-Filling Patterns in the Intracarotid Amobarbital Procedure

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1995.00540310086020
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine behavioral correlates of anterior cerebral artery (ACA) and posterior cerebral artery (PCA) perfusion patterns in the intracarotid amobarbital sodium procedure. Design: Multivariate analysis of covariance and partial correlations of behavioral measures to ACA crossflow and PCA filling. Setting: Angiography and the intracarotid amobarbital procedure at a comprehensive epilepsy center. Subjects: Forty-two patients with intractable epilepsy (right-hemisphere seizure focus [n-23]; left-hemisphere seizure focus [n=19]). Measurements: Internal carotid angiography was performed both at a standard injection rate (8 mL of contrast per second) and at 1 mL/s, which matched the rate of the subsequent amobarbital injection. The degree of ipsilateral PCA and contralateral ACA filling were graded on a seven-point scale and compared with postinjection behavior, language, and memory measures. Results: The ACA crossflow did not correlate significantly with that of any measure. The degree of PCA-filling pattern correlated significantly only with the level of consciousness (r=.31, P<.004), but it was not significant after accounting for the effects of seizure laterality, injection side, and amobarbital dosage. Neither ACA crossflow nor PCA filling correlated significantly with memory. The degree of ACA and PCA filling was overestimated at standard angiography (8 mL of contrast medium per second) injection rates. Conclusions: Although the degree of PCA filling correlates mildly with the level of consciousness postinjection, possibly by perfusion of thalamic or mesencephalic branches, it is not reliably predictive and is less contributory than the injection side and seizure laterality. The PCA filling is not required to produce valid memory assessment in the intracarotid amobarbital procedure, and ACA crossflow is not predictive of behavioral responses. References 1. Branch C, Milner B, Rasmussen T. Intracarotid sodium amytal for the lateralization of cerebral speech dominance . J Neurosurg . 1964;21:399-405.Crossref 2. Jones-Gotman M. Psychological evaluation—testing hippocampal function . In: Engel J Jr, ed. Surgical Treatment of the Epilepsies . New York, NY: Raven Press; 1987:203-211. 3. Loring D, Meador K, Lee G, King D. Amobarbital Effects and Lateralized Brain Function . New York, NY: Springer-Verlag NY Inc; 1992. 4. Rausch R, Risinger M. Intracarotid sodium amobarbital procedure . Neuromethods . 1990;15:127-146. 5. Wada J, Rasmussen T. Intracarotid injection of sodium amytal for lateralization of cerebral speech dominance: experimental and clinical observations . J Neurosurg . 1960;17:266-282.Crossref 6. Lesser RP, Dinner DS, Luders H, Morris HH. Memory for objects presented soon after intracarotid amobarbital sodium injections in patients with medically intractable complex partial seizures . Neurology . 1986;36:895-899.Crossref 7. Carpenter M, Sutin J. Human Neuroanatomy . 8th ed. Baltimore, Md: Williams & Wilkins; 1983. 8. Milner B, Branch C, Rasmussen T. Study of short-term memory and intracarotid injection of sodium amytal . Trans Am Neurol Assoc . 1962;87:224-226. 9. Milner B. Psychological aspects of focal epilepsy and its neurosurgical management . Adv Neurol . 1975;8:299-321. 10. Rausch R, Babb TL, Engel J, Crandall PH. Memory following intracarotid amobarbital injection contralateral to hippocampal damage . Arch Neurol . 1989:46: 783-788.Crossref 11. Gotman J, Bouwer M, Jones-Gotman M. Intracranial EEG study of brain structres affected by internal carotid injection of amobarbital . Neurology . 1992; 42:2136-2143.Crossref 12. DeToledo J, Smith D, Kramer R. A proposed cause for the variability of memory lateralization in amytal suppression (Wada) testing: role of the septal region . Epilepsia . 1989;30:712. 13. Jeffery PJ, Monsein LH, Szabo Z, et al. Mapping the distribution of amobarbital sodium in the intracarotid Wada test by use of Tc-99m HMPAO with SPECT . Radiology . 1991;178:847-850.Crossref 14. Perrine K, Gershengorn J, Brown E, Choi I, Luciano D, Devinsky O. Materialspecific memory in the intracarotid amobarbital procedure . Neurology . 1993; 43:706-711.Crossref 15. Christianson S, Saisa J, Silfvenius H. Hemisphere memory differences in sodium amytal testing of epileptic patients . J Clin Exp Neuropsychol . 1990;12: 681-694.Crossref 16. Engel J Jr, Rausch R, Lieb JP, Kuhl DE, Crandall PH. Correlation of criteria used for localizing epileptic foci in patients considered for surgical therapy of epilepsy . Ann Neurol . 1981;9:215-224.Crossref 17. Fedio P, Weinberg LK. Dysnomia and impairment of verbal memory following intracarotid injection of sodium amytal . Brain Res . 1971;31:159-168.Crossref 18. Loring DW, Lee GP, Meador KJ, et al. The intracarotid amobarbital procedure as a predictor of memory failure following unilateral temporal lobectomy . Neurology . 1990;40:605-610.Crossref 19. Milner B. Disorders of learning and memory after temporal lobe lesions in man . Clin Neurosurg . 1972;19:421-446. 20. Powell GE, Polkey CE, Canavan AGM. Lateralisation of memory functions in epileptic patients by use of the sodium amytal (Wada) technique . J Neurol Neurosurg Psychiatry . 1987;50:665-672.Crossref 21. Rausch R, Fedio P, Ary CM, Engel J Jr, Crandall PH. Resumption of behavior following intracarotid sodium amobarbital injection . Ann Neurol . 1984;15:31-35.Crossref 22. Sass KJ, Lencz T, Westerveld M, Novelly RA, Spencer DD, Kim JH. The neural substrate of memory impairment demonstrated by the intracarotid amobarbital procedure . Arch Neurol . 1991;48:48-52.Crossref 23. Walker JA, Stanulis RG, Laxer KD. What stages of memory do the temporal lobes serve? a sodium amytal perspective . In: Engel J Jr, Ojemann GA, Luders HO, Williamson PD, eds. Fundamental Mechanisms of Human Brain Function . New York, NY: Raven Press; 1987:111-116. 24. Wyllie E, Naugle R, Chelune G, Luders H, Morris HH, Skibinski C. Intracarotid amobarbital procedure, II: lateralizing value in evaluation for temporal lobectomy . Epilepsia . 1991;32:865-869.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jul 1, 1995

References