Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: https://twitter.com/DrFrankYuan.
The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Vasc Interv Radiol. 2023 Sep;34(9):1609-1617.e2. doi: 10.1016/j.jvir.2023.05.016. Epub 2023 May 13.
To 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).
Medical 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.
A 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.
IONM, including provocative testing, during AVM embolization may minimize potential nerve injury.
评估术中神经监测（IONM），包括栓塞前利多卡因注射挑战（“激发测试”）是否与减少外周动静脉畸形（AVM）栓塞过程中不可逆神经损伤的风险有关。
回顾性分析了 2012 年至 2021 年间接受有 IONM 和激发测试的外周 AVM 栓塞治疗的患者的病历。收集的数据包括患者的人口统计学特征、AVM 的位置和大小、使用的栓塞剂、利多卡因和栓塞剂注射后 IONM 信号的变化、术后不良事件和临床结果。是否在特定部位进行栓塞的决策是基于利多卡因挑战后的 IONM 发现以及栓塞过程中的 IONM 发现。
确定了 17 例（平均年龄 27 岁±19 岁；5 例女性）接受了 59 次有足够 IONM 数据的图像引导栓塞手术的患者队列。没有发生永久性神经功能缺损。3 例患者（4 次）出现短暂性神经功能障碍，包括皮肤麻木（2 例）、肢体无力（1 例）和肢体无力伴麻木（1 例）。所有神经功能障碍在术后第 4 天无需额外治疗即可缓解。
IONM，包括激发测试，在 AVM 栓塞过程中可能最小化潜在的神经损伤。
