Embolization of a Spinal Arteriovenous Malformation: Correlation between Motor Evoked Potentials and Angiographic Findings: Technical Case Report

Embolization of a Spinal Arteriovenous Malformation: Correlation between Motor Evoked Potentials... AbstractOBJECTIVEEndovascular procedures for the treatment of spinal arteriovenous malformations place the spinal cord at risk of ischemia. This report illustrates the usefulness of motor evoked potentials (MEPs) in detecting functional changes within the spinal cord motor pathways during embolization of a spinal arteriovenous malformation under general anesthesia.METHODSA 28-year-old man presented with a history of progressive lower extremity numbness and weakness followed by bladder dysfunction. Magnetic resonance imaging and angiography disclosed a T11-T12 spinal arteriovenous malformation.RESULTSDuring the endovascular procedure, before injection of particles, the disappearance of MEPs from the tibialis anterior muscle led to prompt angiographic reevaluation, which disclosed the arrest of spinal blood flow secondary to radiculomedullary artery occlusion by the catheter. Embolization and catheter withdrawal were followed by temporary recovery of spinal blood flow and MEPs. A second arrest of spinal cord blood flow, caused by severe vasospasm of the feeding radiculomedullary artery, was documented by a control angiogram, and its functional relevance was revealed by a second disappearance of MEPs. The therapeutic effect of papaverine infusion and induced moderate hypertension was confirmed angiographically by complete reopacification of the anterior spinal artery and confirmed neurophysiologically by the complete recovery of MEPs. At the end of the procedure, no additional neurological deficits were noted.CONCLUSIONDuring spinal cord embolization, MEPs may play a critical role in early detection of spinal cord dysfunction by aiding in the prevention of damage to the spinal cord as well as by predicting the clinical outcome. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Embolization of a Spinal Arteriovenous Malformation: Correlation between Motor Evoked Potentials and Angiographic Findings: Technical Case Report

Embolization of a Spinal Arteriovenous Malformation: Correlation between Motor Evoked Potentials and Angiographic Findings: Technical Case Report

932 Sala et al. herap eu tic options for the treatmenl Embolization of a Spinal Arteriovenous of spinal arteriovenous malforma­ tions (A V M s) include endovascular em­ Malformation: Correlation between bolization, surgery, or both (9, 16,17) In trav ascu lar procedures usually con­ Motor Evoked Potentials and sist of p relim in ary meticulous and com­ plete spinal angiography, followed b\ Angiographic Findings: Technical em b o lizatio n (2). Because this proce­ dure can require several hours, general Case Report anesthesia is usually preferred by the • ! en d o v a scu la r surgeon and the patient. U n d er general anesthesia, however, spi­ nal cord ischem ia secondary to arterial F r a n c e s c o S a la , M . D . , Y a s u n a ri N iim i, M . D . , v a so sp a sm or unrecognized occlusion M a t e v z J. K rz a n , M . D . , A le x B e re n s te in , M . D . , of an arterial feeder to the cord may not V e d r a n D e le tis , M . D . , P h .D . be detected. W h e n unrecognized, both events m ay result in spinal cord infarc­ Division of Intraoperative Neurophysiology (FS, M)K, VD) and Center for Endovascular Surgery tion with d eleteriou s consequences for (YN, AB), Institute for Neurology and Neurosurgery, Beth Israel Medical Center, the patient. O u r group has used intra­ Singer Division, New York, New York operative neurophysiology for the last 15 years to assist us with continuous feed back on the functional status of the O BJEC T IV E A N D IM PO R T A N C E: Endovascular procedures for the treatment sensory and m otor pathways at risk for of spinal arteriovenous malformations place the spinal cord at risk of ischem ia (3, 18). O ver the past 15 years, ischemia. This report illustrates the usefulness of motor evoked potentials so m a to se n so ry evoked potentials (SEPs) JR (MEPs) in detecting functional changes within the spinal cord motor have b een d ocu m en ted as unable to pre­ dict p osto p erativ e motor...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199910000-00045
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEEndovascular procedures for the treatment of spinal arteriovenous malformations place the spinal cord at risk of ischemia. This report illustrates the usefulness of motor evoked potentials (MEPs) in detecting functional changes within the spinal cord motor pathways during embolization of a spinal arteriovenous malformation under general anesthesia.METHODSA 28-year-old man presented with a history of progressive lower extremity numbness and weakness followed by bladder dysfunction. Magnetic resonance imaging and angiography disclosed a T11-T12 spinal arteriovenous malformation.RESULTSDuring the endovascular procedure, before injection of particles, the disappearance of MEPs from the tibialis anterior muscle led to prompt angiographic reevaluation, which disclosed the arrest of spinal blood flow secondary to radiculomedullary artery occlusion by the catheter. Embolization and catheter withdrawal were followed by temporary recovery of spinal blood flow and MEPs. A second arrest of spinal cord blood flow, caused by severe vasospasm of the feeding radiculomedullary artery, was documented by a control angiogram, and its functional relevance was revealed by a second disappearance of MEPs. The therapeutic effect of papaverine infusion and induced moderate hypertension was confirmed angiographically by complete reopacification of the anterior spinal artery and confirmed neurophysiologically by the complete recovery of MEPs. At the end of the procedure, no additional neurological deficits were noted.CONCLUSIONDuring spinal cord embolization, MEPs may play a critical role in early detection of spinal cord dysfunction by aiding in the prevention of damage to the spinal cord as well as by predicting the clinical outcome.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1999

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