Document Detail


Impact of Changes in Intraoperative Somato-Sensory Evoked Potentials (SSEPs) on Stroke Rates after Clipping of Intracranial Aneurysms.
MedLine Citation:
PMID:  22067420     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Somatosensory evoked potential (SSEP) monitoring is used during intracranial aneurysm surgery to track the effects of anesthesia, surgical manipulation, and temporary clipping. OBJECTIVE: To present the outcomes of 663 consecutive patients (691 cases) treated surgically for intracranial aneurysms who underwent intraoperative SSEP monitoring, and analyze the sensitivity and specificity of significant SSEP changes in predicting postoperative stroke. METHODS: Of 691 surgeries analyzed, 403 (391 anterior circulation, 12 posterior) were unruptured aneurysms and 288 (277 anterior, 11 posterior) were ruptured. Postoperatively, symptomatic patients underwent CT imaging. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were calculated with a Fisher's Exact Test (two-tailed P value). RESULTS: SSEP changes occurred in 45 of 691 cases (6.5%); 16 of 403 (4.0%) in unruptured aneurysms, and 29 of 288 (10%) in ruptured aneurysms. In unruptured aneurysms, reversible SSEP changes were associated with a 20% stroke rate, but irreversible changes with an 80% stroke rate. In ruptured aneurysms, however, reversible changes were associated with a 12% stroke rate, and irreversible changes with a 42% stroke rate. The overall accuracy of SSEP changes in predicting postoperative stroke was PPV=30%, NPV=94%, sensitivity=25%, and specificity=95%. CONCLUSION: Intraoperative SSEP changes are more reliable in unruptured aneurysm cases than in ruptured cases. Whereas irreversible changes in unruptured cases were associated with an 80% stroke rate, such changes in ruptured cases did not have any adverse ischemic sequelae in 58% of patients. This information is helpful during the intraoperative assessment of reported SSEP changes.
Authors:
Robert T Wicks; Gustavo Pradilla; Shaan M Raza; Uri Hadelsberg; Alexander L Coon; Judy Huang; Rafael J Tamargo
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-3
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1The Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD, USA 2Technion Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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