Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization

Publication date: September–October 2018
Source:Clinical Imaging, Volume 51
Author(s): Orhan Bican, Charles Cho, Leslie Lee, Viet Nguyen, Scheherazade Le, Jeremy Heit, Jaime Lopez
A middle-aged patient underwent staged endovascular embolization of a Spetzler-Martin grade V right parietal arteriovenous malformation(AVM).In the fifth endovascular embolization, after methohexital 10 mg injection into a right posterior choroidal artery feeding the AVM nidus, there was an immediate change in the electroencephalogram (EEG) with simultaneous loss of motor evoked potentials (MEPs) in the bilateral upper and lower extremities and a delayed change in somatosensory evoked potential responses (SSEPs). No embolization was made and procedure was terminated. This case demonstrates the utility of intraoperative neurophysiologic monitoring (IONM) with pharmacologic provocative testing in predicting and mitigating the risks prior to the proposed embolization.



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