신경혈관 중재술에서의 신경계감시의 역할: 척추 동정맥 기형의 증례

Abstract

Endovascular embolization is one of the treatment options for spinal arteriovenous malformation (AVM). Intraoperative neurophysiological monitoring (IONM) is widely used in procedures where post-procedure neurological deterioration may occur. 24-year-old man, previously diagnosed with spinal AVM, visited a tertiary hospital complaining of weakness and tingling sensation on both lower extremities. After confirming the right 6th thoracic segmental artery as the target point of the AVM feeder, an endovascular procedure was performed with IONM. During embolization using a nonadhesive liquid embolic agent (Onyx®), the amplitude of motor evoked potentials of the bilateral tibialis anterior and right abductor hallucis brevis were decreased over the alarm criteria. After the procedure, the patient developed weakness in both legs, hypoesthesia, and neurogenic bladder. After 4 weeks of rehabilitation, motor and bladder function partially improved. This case presentation is to emphasize the role of the continuous multimodality IONM in making important decisions during neuroendovascular procedures.