Super-Selective Wada Test for Pre-Surgical Leg Motor Function Assessment: A case report

Abstract

Abstract Introduction: Wada test is well-known to assess lateralization of memory and language functions, however super-selective Wada (ss-Wada) to evaluate motor leg function is rare. We present a ss-Wada test within the anterior cerebral artery (ACA) to assess the motor function of the leg. Methods: Retrospective chart review. Results: Comprehensive phase-I/II surgical evaluation revealed an ictal focus around the left post-central gyrus with immediate involvement around left para-central regions. To avoid potential right leg motor dysfunction with the surgery, the patient underwent a ss-Wada procedure. Angiography revealed bilateral ACAs were supplied by the left A1 segment. Super-selective microcatheter injection of amobarbital into the left ACA was performed to avoid cross-filling the contralateral ACA. The ss-Wada test confirmed no right leg motor impairment. Afterward, a craniotomy with direct cortical stimulation confirmed that the left-sided ictal/peri-ictal zone had no clear leg motor function. Patient underwent disconnection of that region and remained seizure free at 10-month post-op follow up without any motor or sensory deficits in the right limbs. Conclusion: This case demonstrates the proof of concept for ss-Wada in assessing lower extremity motor function. The ss-Wada procedure accurately predicted no motor deficits in right leg, consistent with preserved motor function post-surgery.