Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping
Objective: To investigate the optimal combination of somatosensory- and transcranial motor-evoked potential (SSEP/tcMEP) modalities and monitored extremities during clip reconstruction of aneurysms of the anterior cerebral artery (ACA) and its branches. Methods: A retrospective review of 104 cases o...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Clinical Neurophysiology Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2467981X22000270 |
| _version_ | 1798006436228235264 |
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| author | Ferenc Rabai Claire M. Dorey W. Christopher Fox Krista M. Fitzgerald Christoph N. Seubert Steven A. Robicsek |
| author_facet | Ferenc Rabai Claire M. Dorey W. Christopher Fox Krista M. Fitzgerald Christoph N. Seubert Steven A. Robicsek |
| author_sort | Ferenc Rabai |
| collection | DOAJ |
| description | Objective: To investigate the optimal combination of somatosensory- and transcranial motor-evoked potential (SSEP/tcMEP) modalities and monitored extremities during clip reconstruction of aneurysms of the anterior cerebral artery (ACA) and its branches. Methods: A retrospective review of 104 cases of surgical clipping of ruptured and unruptured aneurysms was performed. SSEP/tcMEP changes and postoperative motor deficits (PMDs) were assessed from upper and lower extremities (UE/LE) to determine the diagnostic accuracy of each modality separately and in combination. Results: PMDs were reported in 9 of 104 patients; 7 LE and 8 UE (3.6% of 415 extremities). Evoked potential (EP) monitoring failed to predict a PMD in 8 extremities (1.9%). Seven of 8 false negatives had subarachnoid hemorrhage. Sensitivity and specificity in LE were 50% and 97% for tcMEP, 71% and 98% for SSEP, and 83% and 98% for dual-monitoring of both tcMEP/SSEP. Sensitivity and specificity in UE were 38% and 99% for tcMEP, and 50% and 97% for tcMEP/SSEP, respectively. Conclusions: Combined tcMEP/SSEP is more accurate than single-modality monitoring for LE but is relatively insensitive for UE PMDs. Significance: During ACA aneurysm clipping, multiple factors may confound the ability of EP monitoring to predict PMDs, especially brachiofacial hemiparesis caused by perforator insufficiency. |
| first_indexed | 2024-04-11T12:54:42Z |
| format | Article |
| id | doaj.art-19e7c6d0956d471dada13010bc8964ce |
| institution | Directory Open Access Journal |
| issn | 2467-981X |
| language | English |
| last_indexed | 2024-04-11T12:54:42Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Neurophysiology Practice |
| spelling | doaj.art-19e7c6d0956d471dada13010bc8964ce2022-12-22T04:23:05ZengElsevierClinical Neurophysiology Practice2467-981X2022-01-017228238Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clippingFerenc Rabai0Claire M. Dorey1W. Christopher Fox2Krista M. Fitzgerald3Christoph N. Seubert4Steven A. Robicsek5Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Anesthesiology, College of Medicine, University of Florida, 1600 Archer Road, PO Box 100254, Gainesville, FL 32610, USA; Corresponding author at: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.Department of Speech, Language and Hearing, University of Florida College of Health and Health Professions, PO Box 100174, Gainesville, FL 32610, USADepartment of Neurosurgery, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USADepartment of Speech, Language and Hearing, University of Florida College of Health and Health Professions, PO Box 100174, Gainesville, FL 32610, USADepartment of Anesthesiology, College of Medicine, University of Florida, 1600 Archer Road, PO Box 100254, Gainesville, FL 32610, USADepartment of Anesthesiology, College of Medicine, University of Florida, 1600 Archer Road, PO Box 100254, Gainesville, FL 32610, USAObjective: To investigate the optimal combination of somatosensory- and transcranial motor-evoked potential (SSEP/tcMEP) modalities and monitored extremities during clip reconstruction of aneurysms of the anterior cerebral artery (ACA) and its branches. Methods: A retrospective review of 104 cases of surgical clipping of ruptured and unruptured aneurysms was performed. SSEP/tcMEP changes and postoperative motor deficits (PMDs) were assessed from upper and lower extremities (UE/LE) to determine the diagnostic accuracy of each modality separately and in combination. Results: PMDs were reported in 9 of 104 patients; 7 LE and 8 UE (3.6% of 415 extremities). Evoked potential (EP) monitoring failed to predict a PMD in 8 extremities (1.9%). Seven of 8 false negatives had subarachnoid hemorrhage. Sensitivity and specificity in LE were 50% and 97% for tcMEP, 71% and 98% for SSEP, and 83% and 98% for dual-monitoring of both tcMEP/SSEP. Sensitivity and specificity in UE were 38% and 99% for tcMEP, and 50% and 97% for tcMEP/SSEP, respectively. Conclusions: Combined tcMEP/SSEP is more accurate than single-modality monitoring for LE but is relatively insensitive for UE PMDs. Significance: During ACA aneurysm clipping, multiple factors may confound the ability of EP monitoring to predict PMDs, especially brachiofacial hemiparesis caused by perforator insufficiency.http://www.sciencedirect.com/science/article/pii/S2467981X22000270Anterior cerebral arteryAnterior communicating arteryCerebral aneurysmIntraoperative neurophysiological monitoringSomatosensory-evoked potentialMotor-evoked potential |
| spellingShingle | Ferenc Rabai Claire M. Dorey W. Christopher Fox Krista M. Fitzgerald Christoph N. Seubert Steven A. Robicsek Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping Clinical Neurophysiology Practice Anterior cerebral artery Anterior communicating artery Cerebral aneurysm Intraoperative neurophysiological monitoring Somatosensory-evoked potential Motor-evoked potential |
| title | Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| title_full | Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| title_fullStr | Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| title_full_unstemmed | Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| title_short | Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| title_sort | utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping |
| topic | Anterior cerebral artery Anterior communicating artery Cerebral aneurysm Intraoperative neurophysiological monitoring Somatosensory-evoked potential Motor-evoked potential |
| url | http://www.sciencedirect.com/science/article/pii/S2467981X22000270 |
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