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120 Background: A major concern in the treatment of  cerebral AVMs is whether so-called eloquent regions occupy normal  anatomic locations. Recently, we have shown with selective anesthetic  injections that language has a wide and unusual distribution in  patients withleft cerebral AVM. Our Objective here was to  determine whether superselective Wada testing in medial  right-hemisphere arteries would produce verbal memory loss in patients  with right cerebral AVM.Methods: Nine patients, 8 right-  and 1 left-handed, had superselective injections of amobarbital sodium  plus lidocaine into vessels near or feeding right medial AVMs. Five  patients had AVMs supplied by PCA feeders and four had ACA feeders.  Memory testing occurred in a no-anesthetic baseline, 1 minute after  anesthetic injection, and 12 minutes after injection. A memory test  consisted of 5 words presented on a computer screen which the patient  had to read aloud. After 3 minutes, recall was tested. A maximum score  was 15, with uncued recall of a word = 3 points, prompted  recall = 2 points, and multiple choice = 1 point. Based on  clinical considerations, various numbers of vessels were tested in each  patient.Results: Superselective anesthetic testing in most  vessels yielded memory scores no different than baseline, and  embolization took place. In each patient, however, there was at least  one vessel feeding the AVM in which significant short-term verbal  memory loss took place. In these instances, the mean memory score at  baseline was 14 (s.d. = 1.5). Following injection of anesthetics, the  mean score fell significantly to 7.1 (t-test, p&lt;.00001). Attention was  unaltered. After dissipation of the anesthesia at 12 minutes, memory  returned to baseline levels in every case.Conclusions: In  nine patients, superselective Wada injection into arteries feedingright medial AVMs produced unanticipated verbal memory  deficits. Traditional assumptions about eloquent regions would have  suggested that such testing would have been unnecessary, but  embolization here would have yielded significant morbidity. Our  findings also question established notions of verbal memory restricted  to the left hemisphere.

Unanticipated memory loss during superselective Wada testing for right cerebral arteriovenous malformation.