Selective Propofol Injection into the M1 Segment of the Middle Cerebral Artery (MCA Wada Test) Reduces Adverse Effects and Enhances the Reliability of the Wada Test for Determining Speech Dominance
| Autor: | Osamu Hososhima, Jun Yoshida, Toshihiko Wakabayashi, Noriaki Matsubara, Tomotaka Ohshima, Shigeru Miyachi, Masazumi Fujii, Takeshi Kinkori, Takashi Izumi, Shigenori Takebayashi, Arihito Tsurumi |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Middle Cerebral Artery Cerebral arteries Posterior cerebral artery Seizures medicine.artery Preoperative Care Anterior cerebral artery Humans Speech Medicine Posterior communicating artery Confusion Dominance Cerebral Propofol Aged Cerebral Hemorrhage Neurologic Examination medicine.diagnostic_test Brain Neoplasms business.industry Reproducibility of Results Middle Aged Magnetic Resonance Imaging Cerebral Angiography Injections Intra-Arterial Anesthesia Middle cerebral artery cardiovascular system Circle of Willis Wada test Female Surgery Neurology (clinical) Internal carotid artery business Anesthetics Intravenous Carotid Artery Internal Psychomotor Performance medicine.drug |
| Zdroj: | World Neurosurgery. 75:503-508 |
| ISSN: | 1878-8750 |
| Popis: | Object The Wada test is had been the most reliable for determining speech dominance. Drugs injected into the internal carotid artery, however, may be heterogeneously distributed as the result of asymmetry of the anterior cerebral arteries and the presence of a fetal-type posterior cerebral artery. Variations in drug distribution could occasionally alter consciousness and complicate the evaluation of the test results. We examined selective propofol injection into the M1 segment of the middle cerebral artery (MCA Wada test). Methods For the MCA Wada test (17 patients), 7 or 8 mg of propofol was injected via a microcatheter navigated into the M1 segment, and language function was evaluated by patient performing several tasks. The conventional Wada test (internal carotid artery [ICA] Wada test) was performed in four patients (both the ICA and MCA Wada tests were performed in one patient). The efficacy and adverse effects of both procedures were evaluated; all tests were performed by well-trained interventional neuroradiologists. Results Immediately after propofol injection during the MCA Wada test, patients developed transient contralateral hemiplegia and transient aphasia (in the case of injection on the dominant side). Confusion and other severe adverse effects did not occur during the MCA Wada test, but two of four patients who underwent the ICA Wada test showed altered consciousness that affected the performance of the test. Conclusions The MCA Wada test is a feasible and reliable preoperative evaluation, if performed by a trained team of interventional neuroradiologists. |
| Databáze: | OpenAIRE |
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