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Ando K, Hiraishi T, Oishi M, Hasegawa H, Kikuchi B, Natsumeda M, Suzuki T, Saito S, Ota T, Yoshida Y, Fujii Y. Endovascular treatment of an infectious aneurysm using the selective provocative test and transcranial motor evoked potential monitoring under general anesthesia: a case report. Acta Neurochir (Wien) 2022; 164:1265-1269. [PMID: 34537902 DOI: 10.1007/s00701-021-05001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
The selective provocative test (SPT) under local anesthesia aids in protecting against ischemic complications during endovascular treatment. However, the use of this test under general anesthesia is not well described. Herein, we present a case of a 51-year-old man with a ruptured fusiform aneurysm in the middle cerebral artery M4 segment, which was thought to possibly supply the motor cortex. Internal trapping of the affected vessel and aneurysm by endovascular intervention was successfully performed after SPT using transcranial motor evoked potential (MEP) monitoring under general anesthesia. Transcranial MEP is suitable for neurological assessment during SPT under general anesthesia.
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Affiliation(s)
- Kazuhiro Ando
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan.
| | - Tetsuya Hiraishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Bumpei Kikuchi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Tomoaki Suzuki
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Shoji Saito
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Tomoyoshi Ota
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Yuichi Yoshida
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachidori, Niigata, Niigata, 951-8585, Japan
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Wang Y, Yu J. Endovascular Treatment and Angiographic Characteristics of Aneurysms at the Origin of the Anterior Choroidal Artery. Front Neurol 2022; 13:832604. [PMID: 35359632 PMCID: PMC8963998 DOI: 10.3389/fneur.2022.832604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background The information available about the variations and anatomy of the anterior choroidal artery (AchA) with aneurysm at the origin of the vessel and the outcomes of endovascular treatment (EVT) for AchA aneurysms is incomplete. Materials and Methods A retrospective study of 54 consecutive patients who were admitted to our hospital with a diagnosis of AchA aneurysm and treated with EVT was performed. The variations and anatomy of the AchA and the outcomes of EVT for AchA aneurysms were analyzed. Result The 54 patients were aged 35–82 years (mean age, 56.1 ± 19.7 years) and included 32 females (59.3%, 32/54). Regarding AchA anatomy, 63.5% of AchAs had a typical S-shaped course. The diameter of the AchA origin averaged 0.8 ± 0.3 mm. Of all the AchA aneurysms, 51.9% were ruptured. The diameter of AchA aneurysms averaged 4.1 ± 2.4 mm. Moreover, 40.7% of 54 cases had multiple aneurysms. EVT was assisted with stenting for 25.9% of 54 AchA aneurysms. An immediate Modified Raymond-Roy Classification grade of I was obtained in 96.3% of AchA aneurysm cases. After EVT, the ischemic complication rate was 13%. In total, 83% of patients had good outcomes, with a Glasgow Outcome Scale score of 4–5. Follow-up angiography showed acceptable treatment results in this study. Conclusion The study showed that the AchA had a complex angiographic anatomy in cases with aneurysms at the origin of the vessel and that the anatomical features can be helpful in EVT. EVT for aneurysms at the origin of the AchA had good outcomes.
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Affiliation(s)
- Yiheng Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Maruyama D, Nanto M, Ogita S, Kishida K, Fujiwara G, Murakami M, Murakami N, Hashimoto N. Super-selective balloon test occlusion with electrophysiological monitoring to occlude angiographically invisible posterior communicating artery perforators with unruptured aneurysm. Acta Neurochir (Wien) 2022; 164:169-172. [PMID: 34850290 DOI: 10.1007/s00701-021-05074-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
Balloon test occlusion (BTO) can predict the ischemic complication risk associated with arterial occlusion. We present a case of an unruptured, broad-necked internal carotid artery-posterior communicating artery (PcomA) aneurysm that was successfully embolized after super-selective BTO of fetal PcomA with electrophysiological monitoring. The proximal portion of the PcomA was internally occluded without causing major neurological deficits, although we observed a small new infarction in the ipsilateral anterior thalamus postoperatively. We recognized small perforators arising from the proximal PcomA during a previous clipping surgery. Super-selective BTO with electrophysiological monitoring could be useful for functional preservation after infarction from angiographically invisible perforators.
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Affiliation(s)
- Daisuke Maruyama
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
| | - Masataka Nanto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shogo Ogita
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kengo Kishida
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Gaku Fujiwara
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Mamoru Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms. Neuroradiology 2021; 64:1221-1229. [PMID: 34791541 DOI: 10.1007/s00234-021-02847-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Intraoperative motor-evoked potential (MEP) monitoring is widely used in the neck clipping of cerebral aneurysms. Little is known regarding the usefulness of intraoperative MEP monitoring in endovascular aneurysm surgery. The purpose of this study was to validate the feasibility of intraoperative MEP monitoring during the coil embolization of anterior choroidal artery (AChA) aneurysms. METHODS Clinical and angiographic data of consecutive patients who underwent coil embolization for unruptured AChA aneurysms with or without intraoperative MEP monitoring between January 2014 and December 2018 at our institute were abstracted and analyzed retrospectively. RESULTS Twenty-three unruptured AChA aneurysms were treated. Eleven patients received MEP monitoring, and three of them experienced intraoperative reduction or disappearance of the MEP wave. Even during MEP changes, AChA filling showed no change in any of the three cases. Although one case with MEP monitoring encountered the disappearance of AChA filling, there was no change in MEP. This might be due to retrograde filling of the AChA from the anastomosis with the lateral posterior choroidal artery. AChA blood flow detected by angiography did not always reflect MEP status. When comparing the presence or absence of MEP monitoring, the volume embolization ratio of coiled aneurysms was significantly better in the MEP group. CONCLUSION Intraoperative MEP monitoring during endovascular coiling for AChA aneurysms may be feasible. AChA blood flow detected by angiography does not always reflect MEP status.
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Asimakidou E, Abut PA, Raabe A, Seidel K. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review. Cancers (Basel) 2021; 13:2803. [PMID: 34199853 PMCID: PMC8200078 DOI: 10.3390/cancers13112803] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/31/2022] Open
Abstract
During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Pablo Alvarez Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
- Department of Neurosurgery, Clínica 25 de Mayo, 7600 Mar del Plata, Argentina
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
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Lee S, Lee H, Choi BS, Jin SC. Unexpected abnormal intraoperative neurophysiologic monitoring change by multiple spontaneous intracerebral haemorrhage during endovascular coiling. Br J Neurosurg 2020; 34:342-345. [PMID: 32116042 DOI: 10.1080/02688697.2020.1719036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a patient with multiple angiographically negative intracerebral haemorrhages, which were recognized by significant changes in intraoperative neurophysiologic monitoring during the coil embolization of a left middle cerebral artery aneurysm.
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Affiliation(s)
- Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyungon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Byung-Sam Choi
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
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Yamada Y, Kato Y, Nouri M, Ganaha T, Oheda M, Ishihara K, Moriya S, Sadato A, Inamasu J, Hirose Y. Predictive Value of Motor Evoked Potential Monitoring during Surgery of Unruptured Anterior Circulation Cerebral Aneurysms. Asian J Neurosurg 2017; 12:644-647. [PMID: 29114276 PMCID: PMC5652088 DOI: 10.4103/ajns.ajns_135_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective and Background: Surgery of unruptured aneurysms is always a great challenge to neurovascular surgeons because no postoperative neurological deficits should be expected postoperatively as the patients are fully asymptomatic before the surgery. Here, we present our experience with selective motor evoked potential (MEP) monitoring of our patients in a 2-year time window. Patients and Methods: From 2012 to 2014, 27 patients with unruptured intracranial aneurysms were operated in our institute with the help of MEP monitoring. All patients underwent endoscope-assisted microsurgery with pre- and post-clipping indocyanine green angiography. Results: In this period, no mortality was observed, but 18.5% of the patients developed postoperative deficits which showed good recovery in all cases. Overall, MEP showed about 90% accuracy in predicting postoperative deficits. Conclusions: MEP as a part of multimodality monitoring of aneurysm surgeries is a valuable tool to improve the outcome. However, we should know its limitations as its results are not always consistent with the outcome.
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Affiliation(s)
- Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Mohsen Nouri
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Tsukasa Ganaha
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Motoki Oheda
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kohei Ishihara
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Shigeta Moriya
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Joji Inamasu
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
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Champeaux C, Jecko V, Eimer S, Penchet G. Usefulness of Motor-Evoked Potentials Monitoring for Neurosurgical Treatment of an Unusual Distal Anterior Choroidal Artery Aneurysm. J Korean Neurosurg Soc 2016; 59:414-9. [PMID: 27446526 PMCID: PMC4954893 DOI: 10.3340/jkns.2016.59.4.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/30/2014] [Accepted: 01/23/2015] [Indexed: 12/29/2022] Open
Abstract
A 35 years old woman presented with an acute meningeal syndrome following an intra ventricular haemorrhage without subarachnoid haemorrhage. The angiography demonstrated a 6 mm partially thrombosed saccular aneurysm at the plexal point of the right anterior choroidal artery (AChoA). It was surgically approached inside the ventricle through a trans-temporal corticotomy. The aneurysm was excised after distal exclusion of the feeding artery under motor-evoked potentials monitoring. Of the 19 cases of distal AChoA aneurysm neurosurgical treatment, this is the only one performed under electrophysiology monitoring, a simple and safe method to detect and prevent motor tract ischemia. We discuss this rare case, along with a comprehensible review of the literature of the previous surgical cases of distal AChoA aneurysms.
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Affiliation(s)
- Charles Champeaux
- Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, United Kingdom
| | - Vincent Jecko
- Department of Neurosurgery, University Hospital of Bordeaux, Pellegrin Hospital, Bordeaux Cedex, France
| | - Sandrine Eimer
- Department of Neuropathology, University Hospital of Bordeaux, Pellegrin Hospital, Bordeaux Cedex, France
| | - Guillaume Penchet
- Department of Neurosurgery, University Hospital of Bordeaux, Pellegrin Hospital, Bordeaux Cedex, France
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Intraoperative Transcranial Motor-Evoked Potentials Predict Motor Function Outcome in Intracerebral Hemorrhage Surgery. World Neurosurg 2016; 90:518-523. [PMID: 27025454 DOI: 10.1016/j.wneu.2016.03.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prediction of motor function after intracerebral hemorrhage (ICH) often poses a diagnostic challenge. This study was performed to investigate whether intraoperative monitoring of motor-evoked potentials (MEPs) could predict postoperative motor function recovery. METHODS We reviewed 16 consecutive patients undergoing evacuation of supratentorial ICH with hemiplegia between June 2011 and October 2014. Patients were categorized according to the results of MEPs before and after evacuation of hematoma. The correlation between detection of MEPs and prognosis of motor function was analyzed. RESULTS In 10 of 16 cases (62%), stable MEPs were detected before and after evacuation of hematoma, and postoperative motor function was improved in all cases, including 3 cases with severe preoperative motor impairment on manual muscle test (1-2). In 3 cases (19%) in which MEPs were not detected throughout the procedure, motor function was not improved. In the other 3 cases (19%), MEPs were not measured before evacuation of ICH but were detected after evacuation despite poor prognosis of motor function. The results of postevacuation MEPs were considered false-negative results. Predictions using pre-evacuation MEP results were completely consistent with prognosis for recovery, whereas MEPs obtained during and after evaluation were useful for monitoring. CONCLUSIONS Intraoperative MEPs may indicate preservation of pyramidal tracts, and pre-evacuation MEPs can predict motor function outcome after ICH surgery.
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Suzuki K, Mikami T, Sugino T, Wanibuchi M, Miyamoto S, Hashimoto N, Mikuni N. Discrepancy between voluntary movement and motor-evoked potentials in evaluation of motor function during clipping of anterior circulation aneurysms. World Neurosurg 2013; 82:e739-45. [PMID: 24036339 DOI: 10.1016/j.wneu.2013.08.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/10/2013] [Accepted: 08/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Various modalities have been used to confirm the blood flow through parent arteries or surrounding perforating arteries during surgical aneurysm clipping, including motor-evoked potentials (MEPs), Doppler ultrasound, and indocyanine green videoangiography. Nonetheless, contralateral hemiparesis due to arterial blood flow insufficiency may arise because of false-positive or false-negative errors. By performing controlled intraoperative awakening during aneurysm clipping, we compared patients' voluntary movements with simultaneous MEP. METHODS Four patients with anterior choroidal artery aneurysms and one patient with a dorsal internal carotid artery aneurysm were included in this study. MEP and intraoperative voluntary movements under awake craniotomy were assessed simultaneously during and after the clipping procedure. RESULTS Aneurysms were safely and successfully clipped in all patients, with no evidence of postoperative neurological deficits. Voluntary movements and MEP findings did not differ from the control state in three patients. In the other two patients, we observed a discrepancy between MEP amplitudes and voluntary movements. In one patient, deterioration and subsequent improvement in voluntary movements were preceded by MEP amplitude reduction during clipping. In the other patient, MEP amplitude did not change although voluntary movement deteriorated during temporary occlusion of the internal carotid artery. CONCLUSIONS Intraoperative neurological assessment during aneurysmal clipping under awake craniotomy is feasible and safe, and should be valuable for the assessment of ischemia, especially in the anterior choroidal artery. From a neurophysiologic viewpoint, MEP may be insufficiently sensitive for evaluating voluntary movement under ischemia.
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Affiliation(s)
- Kengo Suzuki
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Toshiya Sugino
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
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Horton TG, Barnes M, Johnson S, Kalapos PC, Link A, Cockroft KM. Feasibility and efficacy of transcranial motor-evoked potential monitoring in neuroendovascular surgery. AJNR Am J Neuroradiol 2012; 33:1825-31. [PMID: 22517278 DOI: 10.3174/ajnr.a3017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures. MATERIALS AND METHODS We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events. RESULTS Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits. CONCLUSIONS These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.
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Affiliation(s)
- T G Horton
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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