PREEMBOLIZATION FUNCTIONAL-EVALUATION IN SUPRATENTORIAL CEREBRAL ARTERIOVENOUS-MALFORMATIONS WITH SUPERSELECTIVE INTRAARTERIAL INJECTION OFTHIOPENTAL SODIUM SOLUTION

Superselective intraarterial injections of thiopental sodium solution for evaluation of local brain function were performed before embolizat ion in 38 consecutive patients with supratentorial arteriovenous malfo rmations to evaluate the role of the lest using thiopental sodium solu tion. Thiopental sodium (30-50 mg) was injected in 68 arteries (44 mid dle cerebral arteries, 13 anterior cerebral arteries, 7 posterior cere bral arteries, 3 external carotid arteries, and 1 thalamo-perforating artery) through superselective microcatheters just before the injectio n of cyanoacrylate mixture for the embolization. The test was negative in 57 arteries and there were neurologic dysfunctions in 3 of them af ter embolization. The neurologic deficits in these cases were caused b y reflux of embolic material, spasm of the main arterial trunk, or neg lected mild sensory change, respectively, and there was no real false- negative test. The embolization could not be performed due to positive test in 9 arteries. Two arteries with positive tests but acceptable s ymptoms were embolized and the same neurologic deficits developed imme diately after embolization. There was no local arterial complication b y an injection of the thiopental sodium solution. All neurologic defic its caused by positive tests developed immediately and were completely relieved within 5 min without specific management. Superselective int raarterial injection of thiopental sodium solution is a safe and relia ble test for the evaluation of local brain function before embolizatio n of supratentorial arteriovenous malformations.