Superselective Provocative Test with Propofol Using Motor-Evoked Potential Monitoring for Managing Cerebral Arteriovenous Malformations Fed by the Anterior Choroidal Artery

When feeder artery obliteration is performed via an endovascular procedure to treat cerebral arteriovenous malformation (AVM), it is important to prevent the ischemic complications that are associated with feeder occlusion. A provocative test may be beneficial in some cases to protect against ischemic complications. We report the case of a 57-year-old man who developed an intracerebral hematoma in the left internal temporal lobe and who had an AVM with a varix in the ambient cistern, which was primarily fed by a branch of the left anterior choroidal artery (AChA) and the posterior lateral choroidal artery, and drained into the basal vein. Therefore, we planned endovascular obliteration of the AChA, followed by gamma knife radiosurgery for the residual posterior component. The patient underwent a superselective provocative test with a 3 mg of propofol under general anesthesia using motor-evoked potential monitoring. The feeder embolization was performed as planned after the provocative test, and the patient exhibited no neurological deficits, such as hemiparesis, during the procedure.