Selective propofol injection into the M1 segment of the middle cerebral artery (MCA Wada test) reduces adverse effects and enhances the reliability of the Wada test for determining speech dominance.

Abstract

OBJECT:

The Wada test is had been the most reliable for determining speech dominance. Drugs injected into the internal carotid artery, however, may be heterogeneously distributed as the result of asymmetry of the anterior cerebral arteries and the presence of a fetal-type posterior cerebral artery. Variations in drug distribution could occasionally alter consciousness and complicate the evaluation of the test results. We examined selective propofol injection into the M1 segment of the middle cerebral artery (MCA Wada test).

METHODS:

For the MCA Wada test (17 patients), 7 or 8 mg of propofol was injected via a microcatheter navigated into the M1 segment, and language function was evaluated by patient performing several tasks. The conventional Wada test (internal carotid artery [ICA] Wada test) was performed in four patients (both the ICA and MCA Wada tests were performed in one patient). The efficacy and adverse effects of both procedures were evaluated; all tests were performed by well-trained interventional neuroradiologists.

RESULTS:

Immediately after propofol injection during the MCA Wada test, patients developed transient contralateral hemiplegia and transient aphasia (in the case of injection on the dominant side). Confusion and other severe adverse effects did not occur during the MCA Wada test, but two of four patients who underwent the ICA Wada test showed altered consciousness that affected the performance of the test.

CONCLUSIONS:

The MCA Wada test is a feasible and reliable preoperative evaluation, if performed by a trained team of interventional neuroradiologists.

• Authors: Masazumi Fujii, Shigeru Miyachi, Noriaki Matsubara, Takeshi Kinkori, Shigenori Takebayashi, Takashi Izumi, Tomotaka Ohshima, Arihito Tsurumi, Osamu Hososhima, Toshihiko Wakabayashi, Jun Yoshida
• Journal: World neurosurgery (World Neurosurg) 2011 Mar-Apr Vol. 75 Issue 3-4 Pg. 503-8 ISSN: 1878-8769 [Electronic] United States
• PMID: 21600504 (Publication Type: Case Reports, Journal Article)
• Copyright: Published by Elsevier Inc.

Chemical References

• Anesthetics, Intravenous
• Propofol

Topics

• Adult
• Aged
• Anesthetics, Intravenous (administration & dosage, adverse effects)
• Brain Neoplasms (complications, pathology, surgery)
• Carotid Artery, Internal
• Cerebral Angiography
• Cerebral Hemorrhage (etiology, pathology)
• Circle of Willis (anatomy & histology, physiology)
• Confusion (chemically induced, psychology)
• Dominance, Cerebral (physiology)
• Female
• Humans
• Injections, Intra-Arterial
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Middle Cerebral Artery (physiology)
• Neurologic Examination (adverse effects)
• Preoperative Care
• Propofol (administration & dosage, adverse effects)
• Psychomotor Performance (drug effects, physiology)
• Reproducibility of Results
• Seizures (etiology)
• Speech (physiology)