Intraoperative Neuromonitoring during Peripheral Arteriovenous Malformation Embolization |
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Institution: | 1. The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America;2. The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America;3. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Biostatistics, Epidemiology and Environmental Health Sciences, United States of America;4. The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Neuroradiology, United States of America |
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Abstract: | PurposeTo evaluate whether intraoperative neuromonitoring (IONM), including pre-embolization lidocaine injection challenge (“provocative testing”) is associated with reduced risk of irreversible nerve injury during embolization of peripheral arteriovenous malformations (AVMs).Materials and MethodsMedical records of patients with peripheral AVMs who underwent embolotherapy with IONM with provocative testing between 2012 and 2021 were reviewed retrospectively. Data collected included patient demographic characteristics, AVM location and size, embolic agent used, IONM signal changes after lidocaine and embolic agent injections, postprocedural adverse events, and clinical outcomes. Decisions regarding whether embolization would proceed at specific locations were based on IONM findings after the lidocaine challenge and as embolization proceeded.ResultsA cohort of 17 patients (mean age, 27 years ± 19; 5 women) who underwent 59 image-guided embolization procedures with adequate IONM data was identified. No permanent neurologic deficits occurred. Transient neurologic deficits were observed in 3 patients (4 sessions), comprising skin numbness (2 patients), extremity weakness (1 patient), and extremity weakness and numbness (1 patient). All neurologic deficits resolved by postoperative day 4 without additional treatment.ConclusionsIONM, including provocative testing, during AVM embolization may minimize potential nerve injury. |
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Keywords: | AVM"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"arteriovenous malformation IONM"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"intraoperative neuromonitoring MNCS"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"motor nerve conduction study SSEP"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"somatosensory evoked potential TcMEP"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"transcranial motor evoked potential |
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