51. Efficacy and safety of pharmacologic provocative testing with methohexital and intraoperative neurophysiologic monitoring in endovascular embolization procedures

Autor: Paul Shkurovich-Bialik, Areli Rosario Suarez-Roman, Jaime R. Lopez, Orhan Bican
Rok vydání: 2016
Předmět:
Zdroj: Clinical Neurophysiology. 127:e314
ISSN: 1388-2457
DOI: 10.1016/j.clinph.2016.05.326
Popis: Objective The purpose of this study is to evaluate the efficacy and reliability of pharmacologic provocative testing with methohexital (PPTM) using intraoperative neurophysiologic monitoring (IONM) in endovascular embolization procedures (EEPs). Methods 111 EEPs cases were retrospectively reviewed between 2014 and 2015. PPTM and IONM was performed in 70 cases. The data, including cerebrovascular territory tested, PPTM dose, IONM modalities, PPTM results, and postoperative neurologic outcomes were obtained via chart review. Results Mean age was 28.2 years. 85.7% of the cases were cerebral arteriovenous malformations. Mean PPTM dose was 10.8 mg. Two positive tests were detected; one causing widespread loss of SSEPs and TcMEPs, embolization was deferred; and other with burst-suppression EEG immediately after PPTM administration, with embolization done at a different site. There were no false negative cases. Thus, the negative predictive value was 1.0. Conclusion Our results regarding PPTM and IONM indicate the following: it is safe: can aid in intraoperative management; is accurate in predicting postoperative neurologic outcome; and that it is a useful adjunct for EEPs. Significance Use of PPTM combined with IONM has not been previously described in the literature. Our study provides evidence of the utility and safety of PPTM in EPPs.
Databáze: OpenAIRE
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