Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

Abstract

<jats:p> Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults. </jats:p>

Intraoperative neurophysiology monitoring in scoliosis surgery in children

“…The risk appears to be higher for those with pre-existing deficits, especially neurological, and those with multisystem involvement. Tailored intraoperative neuromonitoring (INM) with transcranial electrical motor evoked potentials (TcMEP), somatosensory evoked potentials (SSEP), free running electromyograms (EMG) and stimulus triggered EMG (Stim EMG) may mitigate the risk of permanent injury and adverse neurological outcomes during certain surgeries ( Cheng et al, 2014 , Lieberman et al, 2008 , Senkoylu et al, 2017 , Novais et al, 2017 , Neira et al, 2016 , Piasecki et al, 2018 , Purger et al, 2015 , Samdani et al, 2016 , Galloway and Zamel, 2011 , Pastorelli et al, 2015 , Jea, 2014 , Sala et al, 2010 , Nuwer et al, 2012b , Fehlings et al, 2010 , Langeloo et al, 2003 , McIntyre et al, 2016 ).…”