Document Detail


Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery.
MedLine Citation:
PMID:  15035273     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The aims of this study were to compare the efficiency of motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and microvascular Doppler ultrasonography (MDU) in the detection of impending motor impairment from subcortical ischemia in aneurysm surgery; to determine their sensitivity for specific intraoperative events; and to compare their impact on the surgical strategy used. METHODS: Motor evoked potentials, SSEPs, and MDU were monitored during 100 operations for 129 aneurysms in 95 patients. Intraoperative events, monitoring results, and clinical outcome were correlated in a prospective observational design. Motor evoked potentials indicated inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels in 21 of 33 instances and deteriorated despite stable SSEPs in 18 cases. Microvascular Doppler ultrasonography revealed inadvertent vessel occlusion in eight of 10 cases and insufficient clipping in four of four cases. Stable evoked potentials (EPs) allowed safe, permanent vessel occlusion or narrowing despite reduced flow on MDU in five cases. Two patients sustained permanent and 10 showed transient new weakness, which had been detected by SSEPs in two of 12 patients and MEPs in 10 of 11 monitored cases. The surgical strategy was directly altered in 33 instances: by MEPs in 16, SSEPs in four, and MDU in 13. CONCLUSIONS: Monitoring of MEPs is superior to SSEP monitoring and MDU in detecting motor impairment, particularly that from subcortical ischemia. Microvascular Doppler ultrasonography is superior to EP monitoring in detecting inadvertent vessel occlusion, but cannot assess remote collateral flow. Motor evoked potentials are most sensitive to all other intraoperative conditions and have a direct influence on the course of surgery in the majority of events. A controlled study design is required to confirm the positive effect of monitoring on clinical outcome in aneurysm surgery.
Authors:
Georg Neuloh; Johannes Schramm
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  100     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-23     Completed Date:  2004-04-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  389-99     Citation Subset:  AIM; IM    
Affiliation:
Klinik und Poliklinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany. neuloh@ukb.uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Brain / blood supply,  radiography
Brain Ischemia / diagnosis,  etiology
Cerebrovascular Circulation / physiology
Evoked Potentials, Motor / physiology*
Evoked Potentials, Somatosensory / physiology*
False Negative Reactions
Female
Humans
Intracranial Aneurysm / complications,  surgery*,  ultrasonography*
Male
Microsurgery / instrumentation*
Middle Aged
Monitoring, Intraoperative*
Neurosurgical Procedures / instrumentation*
Postoperative Care
Prospective Studies
Severity of Illness Index
Subarachnoid Hemorrhage / diagnosis,  etiology
Tomography, X-Ray Computed
Ultrasonography, Doppler / methods*

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