The leading-edge for neuroscience and neuroendovascular surgery, Mohammad Moussavi, MD, director of Neurovascular and Neuroendovascular Surgery, performed the first Wada Test on Staten Island.
Wada testing is commonly performed as a pre-surgical procedure for patients being evaluated for epilepsy, tumors, or abnormal vascular concerns to determine whether or not brain surgery may be performed without affecting language and memory skills.
“The left side of the brain leads the right side of the body’s mobility, while the right side of the brain leads the left side. However, when it comes to language and/or memory, it would need to be determined through this procedure,” said Dr. Moussavi. “There is no clear answer to which side of the body controls how much of these functions.”
Retired New York City Fire Lieutenant Thomas Droppa underwent the first for Staten Island after suffering a brain bleed and cerebral edema – swelling in the brain – over a long period of time.
A multiple-disciplinary team of neurointerventionist, neurologist and a neuropsychologist are required for the sophisticated procedure. Wada testing determines cerebral language and memory representation of each hemisphere by deactivating the hemispheres one at a time. A short-acting numbing medication, in this case a Barbiturate is administered into the right and left internal carotid arties through a cannula or an intra-arterial catheter.
During this test the patient is monitored by an EEG and is clinically evaluated throughout the procedure by neurologist, Yasir El-Sherif, MD, director of Stroke Services at Staten Island University Hospital (SIUH). “When the injection is made, we are following the EEG to confirm the brain has been fully suppressed – put to sleep,” said Dr. El-Sherif.
Each hemisphere is monitored during the time of deactivation – when the medication is introduced and after the effect of medication has worn off.
“During brain deactivation not only the contralateral side should become paralyzed but also the EEG of affected brain should show significant electrical suppression,” said Dr. El-Sherif.
To evaluate brain function, neuropsychologist Rosemarie Basile, PhD, director of Psychological Services at SIUH, asked Droppa language and memory questions with objects, pictures and number recognition. The questions help to indicate which parts of the brain are functioning and the ones that are suppressed.
“The neuropsychological component to the exam is imperative as it tests the patient’s visual and verbal memory. It localizes these characteristics, which could be specific to one side or a combination of both sides of the brain,” said Dr. El-Sherif.
Dr. Moussavi added, “We also can perform Super-Selective Wada test as well, in which only a small portion of brain is the point of concern. In this test only that small portion becomes temporarily numb and deactivated in order to find out its specific function. This is performed by sending a very small catheter all the way in the smaller branches of the main arteries of the brain which supplies that area.”
Following the procedure, Droppa spent only a few hours in the hospital and was discharged home same day.
“I think Staten Island University Hospital had all the perfect doctors for my case. They never gave up trying, they kept fighting to get an answer,” explained Mr. Droppa.