Provocative Testing During Arteriovenous Malformation (AVM) Embolization
By Admin | July 17, 2023
Imagine facing a neurological challenge that turns your world upside down. The condition facing you is characterized by a labyrinth of abnormal vessels, weaving intricate connections between arteries and veins. Within this intricate tapestry, there's a notable absence of the usual intervening brain tissue, creating a structure that eerily resembles a bird's nest.
The consequences of this condition are profound as they bring symptoms such as headaches, seizures, neurological deficits, potential intracranial bleeding, and a high risk of death.
This is the story of a 30-year-old patient living with Arteriovenous Malformation (AVM). Our patient presented with a previously ruptured left-frontal AVM and reported regular headaches in addition to also taking medication for seizures. Thankfully, because this patient was right hemispheric language dominant, it made him a good candidate for embolization — a technique used to decrease blood flow through an AVM to minimize blood loss and allow a safer resection of the AVM during surgery.
Arteriovenous Malformation (AVM) is a rare, congenital condition. It consists of a tangle of abnormal vessels connecting arteries and veins with no normal intervening brain tissue and resembles a “bird’s nest” in structure. This malformation can cause headaches, neurological deficits, and seizures. AVMs can also eventually rupture, which can lead to intracranial bleeding and a high risk of death. Embolization is a technique utilized to decrease blood flow through the AVM to minimize blood loss and allow a safer resection of the AVM during a subsequent surgery due to a lower likelihood of postoperative deficits.
So begins the first stage of a two-part embolization and resection of the AVM. After the surgeon guided a catheter through the patient’s groin to the location of the AVM, they administered lidocaine to begin. Due to the potential for blood flow into major cortical arteries from the targeted vessel, motor evoked potentials were then run each minute to monitor for changes.
The surgeon was able to safely embolize the Arteriovenous Malformation without causing new motor deficits and the patient woke up after the procedure with no new deficits. If changes had occurred, the surgeon would have needed to change their approach and continue testing until no motor changes were seen so that a safe embolization could be ensured.
Due to the surgeon running the motor evoked potentials every minute and carefully monitoring changes during the embolization the patient was able to undergo a craniotomy for resection of his AVM four days later. If the potential changes due to the embolization were not tested in advance, it could have led to ischemia or infarction of the cerebral cortex causing severe postoperative motor deficits.
Axis Neuromonitoring stands committed to providing high-quality intraoperative neurophysiological monitoring (IONM) and using it to unlock the full potential of Arteriovenous Malformation embolization. For more information on the transformative benefits of neuromonitoring and its impact on surgical outcomes, please contact us at 888-344-2947.
