Deveikis J P
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109, USA.
AJNR Am J Neuroradiol. 1996 Jun-Jul;17(6):1143-7.
To present the results of a protocol for embolization in the external carotid territory that includes provocative testing with amobarbital sodium and lidocaine.
Provocative testing with sequential intraarterial injections of amobarbital sodium and lidocaine was done before embolization of 66 vascular pedicles in 26 patients with the following pathologic disorders: 8 meningiomas, 7 paragangliomas, 5 dural arteriovenous fistulas, 3 angiofibromas, 1 endolymphatic sac carcinoma, 1 metastatic renal carcinoma, and 1 Rendu-Osler-Weber syndrome. Findings during provocative testing and any postembolization deficits were recorded.
Of the 66 vascular pedicles tested, only 1 showed positive findings on an amobarbital test, in which the patient had transient numbness in the contralateral leg. Results of lidocaine tests were positive, in 7 cases, in which cranial nerve deficits were suspected on the basis of anatomic findings. All deficits resolved within 15 minutes. If results of amobarbital or lidocaine tests were positive, large particles or coils were used for embolization. Otherwise, small particles or liquid agents were used. There were no complications after embolization.
Provocative testing with amobarbital can reveal dangerous anastomoses. Testing with lidocaine can show vascular supply to the cranial nerves. With the use of appropriate protocols, embolization in the external carotid territory can be done with minimal risk.
介绍一项关于颈外动脉区域栓塞治疗方案的结果，该方案包括用戊巴比妥钠和利多卡因进行激发试验。
在对26例患有以下病理疾病的患者的66个血管蒂进行栓塞之前，通过依次动脉内注射戊巴比妥钠和利多卡因进行激发试验：8例脑膜瘤、7例副神经节瘤、5例硬脑膜动静脉瘘、3例血管纤维瘤、1例内淋巴囊癌、1例转移性肾癌和1例遗传性出血性毛细血管扩张症。记录激发试验期间的发现以及任何栓塞后缺损情况。
在测试的66个血管蒂中，只有1个在戊巴比妥试验中显示阳性结果，该患者对侧腿部出现短暂麻木。利多卡因试验结果阳性的有7例，根据解剖学发现怀疑有颅神经缺损。所有缺损在15分钟内均得到缓解。如果戊巴比妥或利多卡因试验结果为阳性，则使用大颗粒或弹簧圈进行栓塞。否则，使用小颗粒或液体剂。栓塞后无并发症发生。
戊巴比妥激发试验可揭示危险的吻合支。利多卡因试验可显示颅神经的血管供应。采用适当的方案，颈外动脉区域的栓塞治疗风险可降至最低。
