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Superselective Wada test for ruptured spontaneous fusiform middle cerebral artery aneurysm: a technical case report.
MedLine Citation:
PMID:  21990832     Owner:  NLM     Status:  In-Data-Review    
Background Spontaneous fusiform aneurysms of the middle cerebral artery (sfaMCA) are quite uncommon and tend to occur in young adults. The use of superselective angiography for ruptured and unruptured aneurysms can help delineate vital angioarchitecture and assist with perioperative planning and treatment modality. The use of superselective Wada testing (SWT) for treatment of a ruptured sfaMCA involving the dominant hemisphere, however, has never been described in the English literature. We report a case of a ruptured sfaMCA involving the dominant hemisphere where superselective angiography and SWT were utilized to predict the ability to occlude a major vessel without adverse neurological sequelae. Case description A healthy young patient presented with subarachnoid hemorrhage. Initial CT-angiogram of the head identified a left-sided fusiform MCA aneurysm measuring 1.3 cm by 0.5 cm in maximum dimensions. Diagnostic angiography evaluation demonstrated an irregular, fusiform aneurysm involving the central (Rolandic) trunk of the left MCA. An SWT was then performed through an SL 10 microcatheter with injection of sodium amytal. Verbal, motor and cognitive testing were performed twice and revealed no neurological defects. The patient underwent subsequent coil embolization of the aneurysm. Formal post-procedure evaluation revealed no speech, language or cognitive deficits. She was eventually discharged home and remained without neurological deficits at her follow-up appointment 12 months after her initial presentation. Conclusion Intraoperative SWT can be performed as part of the initial evaluation for patients with sfaMCA of the dominant cerebral hemisphere to help choose the appropriate treatment algorithm and predict post-treatment neurological deficits.
Sharad Rajpal; Roham Moftakhar; Andrew M Bauer; Aquilla S Turk; David B Niemann
Publication Detail:
Type:  Journal Article     Date:  2011-02-02
Journal Detail:
Title:  Journal of neurointerventional surgery     Volume:  3     ISSN:  1759-8486     ISO Abbreviation:  J Neurointerv Surg     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101517079     Medline TA:  J Neurointerv Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  237-41     Citation Subset:  IM    
Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin, USA.
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