The Neurodiagnostic journal
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Embolization of a spinal cord arteriovenous malformation (AVM) is considered a high-risk procedure due to the potential risk of spinal cord injury. We present two cases illustrating the benefits of utilizing pharmacologic provocative testing under general anesthesia with continuous neurophysiologic monitoring of somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (TCeMEPs) to identify the functional territory of the catheterized vessels prior to embolization. ⋯ Multimodality IONM with continuous SSEP, TCeMEP, and EMG monitoring was utilized effectively during provocative testing with lidocaine and propofol. IONM helped in predicting and preventing post-operative neurological deficits due to ischemia to the spinal cord.