Super-selective Injection of Propofol into the Intracranial Arteries Enables Patient's Self-evaluation of Expected Neurological Deficit

Elsevier

Available online 19 May 2024

CortexAuthor links open overlay panel, , , , , , , , , , , , , , AbstractIntroduction

It is hard to realize the extent of the expected postoperative neurological deficit for patients themselves. The provision of appropriate information can contribute not only to examining surgical indications but also to filling the gap between patient and expert expectations. We hypothesized that propofol infusion into the intracranial arteries (ssWada) could induce focal neurological symptoms with preserved wakefulness, enabling the patients to evaluate the postsurgical risk subjectively.

Methods

Presurgical evaluation using ssWada was performed in 28 patients with drug-resistant epilepsy. Based on anatomical knowledge, propofol was super-selectively infused into the intracranial arteries including the M1, M2, and M3 segments of the middle cerebral artery (MCA), A2 segment of the anterior cerebral artery, and P2 segment of the posterior cerebral artery to evaluate the neurological and cognitive symptoms. We retrospectively analyzed a total of 107 infusion trials, including their target vessels, and elicited symptoms of motor weakness, sensory disturbance, language, unilateral hemispatial neglect (UHN), and hemianopsia. We evaluated preserved wakefulness which enabled subjective evaluations of the symptoms and comparison of the subjective experience to the objective findings, besides adverse effects during the procedure.

Results

Preserved wakefulness was found in 97.2% of all trials. Changes in neurological symptoms were positively evaluated for motor weakness in 51.4%, sensory disturbance in 5.6%, language in 48.6%, UHN in 22.4%, and hemianopsia in 32.7%. Six trials elicited seizures. Multivariate analysis showed significant correlations between symptom and infusion site of language and left side, language and MCA branches, motor weakness and A2 or M2 superior division, and hemianopsia and P2. Transient adverse effect was observed in 8 cases with 12 infusion trials (11.2 %).

Conclusion

The ssWada could elicit focal neurological symptoms with preserved wakefulness. The methodology enables specific evaluation of risk for cortical resection and subjective evaluation of the expected outcome by the patients.

Keywords

Epilepsy surgery

Super-selective infusion

Preserved wakefulness

Subjective evaluation

Neuropsychological test

AbbreviationECS

electrocortical stimulation

ICA

internal carotid artery

MCA

middle cerebral artery

ACA

anterior cerebral artery

PCA

posterior cerebral artery

ssWada

super-selective Wada test

UHN

unilateral hemispatial neglect

© 2024 The Author(s). Published by Elsevier Ltd.

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