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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(03): 430-432
DOI: 10.1055/s-0042-1755244
Case Report

Superselective Anesthesia Functional Examination of the Diaphragm during Endovascular Embolization of Spinal Cord Arteriovenous Malformation

Suparna Bharadwaj
1   Department of Neuroanaesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Radhakrishnan Muthuchellappan
1   Department of Neuroanaesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Abstract

Superselective anesthesia functional evaluation (SAFE) is an adjunct to the Wada test. It is performed to rule out unintentional positioning of the tip of the embolization catheter proximal to the origin of a normal artery supplying eloquent region of spinal cord. We report a case of a 36-year-old male with cervical intramedullary spinal cord arteriovenous malformation (SCAVM) at C3 level. In this patient, we monitored motor-evoked potentials (MEPs) of bilateral upper and lower limbs along with diaphragm. Electrodes for compound muscle action potential of diaphragm were placed under fluoroscopy guidance. Through this case, we want to emphasize that intraprocedural diaphragmatic MEPs enhance the safety margin during endovascular embolization of cervical intramedullary SCAVMs. Placement of electrodes under fluoroscopy guidance ensures proper positioning into the diaphragm muscle.

Keywords

SAFE - provocative test - diaphragmatic motor evoked potentials - cervical intramedullary AVM


Publication History

Article published online:
23 August 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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