The role of digital subtraction cerebral angiography and the Wada test in the pediatric population

Abstract

Catheter cerebral angiography in the pediatric population remains the 'gold standard' diagnostic modality for assess- ment of a number of neurovascular disorders. Although its use has declined due to advances in noninvasive imaging techniques, its ability to resolve and provide dynamic assessment of small vessels, vascular lesions and arteriovenous shunts/fistulae makes it an invaluable tool in the assessment and treatment planning for a number of cerebrovascular disorders. A number of subtle and significant differences exist between pediatric and adult cerebral catheter angiography, including methods of vascular access, catheter selection, contrast administration, and sedation requirements. Similarly, the indications for cerebral angiography are more varied compared with adults. Understanding the differences between pediatric and adult cerebral catheter angiography is essential to ensure safe and appropriate use of the investigation, and to minimize the associated risks. The selective intracar- otid administration of sodium amytal (Wada) test is a tool for assessment of language dominance and memory in a select group of patients for preoperative epilepsy surgery planning. In addition to discussing the principles of the test, indications and contra- indications, a number of specific issues pertaining to performing the Wada test in the pediatric population will also be addressed.