Detection of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Using Motor Evoked Potentials

Grossauer, Stefan; Koeck, Katharina; Kraschl, Jakob; Olipitz, Oliver; Hausegger, K. A.; Vince, Giles H.

doi:10.1227/neu.0000000000001040

Cited by 5 publications

(3 citation statements)

References 37 publications

(47 reference statements)

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“…Theoretically, intraoperative MEP and SEP monitoring can detect neurophysiological changes in the motor cortex/ corticospinal and spinothalamic pathways, respectively, before an actual brain infarction, as inhibition of synaptic transmission occurs before irreversible damage. 14,17,19,23,44,46 However, observation and evaluation of sensory function changes is more difficult than observation and evaluation of motor function changes. Thus, clinicians usually focus on MEP monitoring results and consider SEP results as supplemental information that can provide greater coverage of brain lesions with the advantage of continuous monitoring.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Chung¹,

Park²,

Hong³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Somatosensory and motor evoked potentials (SEPs and MEPs) are often used to prevent ischemic complications during aneurysm surgeries. However, surgeons often encounter cases with suspicious false-positive and false-negative results from intraoperative evoked potential (EP) monitoring, but the incidence and possible causes for these results are not well established. The aim of this study was to investigate the efficacy and reliability of EP monitoring in the microsurgical treatment of intracranial aneurysms by evaluating false-positive and false-negative cases. METHODS From January 2012 to April 2016, 1514 patients underwent surgery for unruptured intracranial aneurysms (UIAs) with EP monitoring at the authors' institution. An EP amplitude decrease of 50% or greater compared with the baseline amplitude was defined as a significant EP change. Correlations between immediate postoperative motor weakness and EP monitoring results were retrospectively reviewed. The authors calculated the sensitivity, specificity, and positive and negative predictive values of intraoperative MEP monitoring, as well as the incidence of false-positive and false-negative results. RESULTS Eighteen (1.19%) of the 1514 patients had a symptomatic infarction, and 4 (0.26%) had a symptomatic hemorrhage. A total of 15 patients showed motor weakness, with the weakness detected on the immediate postoperative motor function test in 10 of these cases. Fifteen false-positive cases (0.99%) and 8 false-negative cases (0.53%) were reported. Therefore, MEP during UIA surgery resulted in a sensitivity of 0.10, specificity of 0.94, positive predictive value of 0.01, and negative predictive value of 0.99. CONCLUSIONS Intraoperative EP monitoring has high specificity and negative predictive value. Both false-positive and false-negative findings were present. However, it is likely that a more meticulously designed protocol will make EP monitoring a better surrogate indicator of possible ischemic neurological deficits.

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Section: Discussionmentioning

confidence: 99%

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Chung¹,

Park²,

Hong³

et al. 2019

Journal of Neurosurgery

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“…As a result, its special usefulness in ICU due to quick results and recording tolerability, although limited in diagnostic. Hence, it can contribute to a reduction in rate of cerebral ischemia following vasospasm [3,53].…”

Section: Discussion Vascular Proceduresmentioning

confidence: 99%

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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Background: Nowadays, intraoperative evoked potentials are recommended in a variety of procedures but there is still a lack of standard protocols and consensus about warning criteria. Moreover, studies are now being made to fundament its risk-beneficial ratio through recordings' predictive value for short and long term outcomes. Furthermore, wake up test limitations encouraged intraoperative evoked potentials research, a reliable monitoring technology.

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“…Surgery-related neurological deicits often arise from direct damage to the cortical or subcortical structures or from ischemia [3,4]. Preservation of the patients' motor functions, while achieving a maximum resection of tumor, can be only achieved by monitoring and locating motor areas and motor tracts intraoperatively [5,6].…”

Section: Introductionmentioning

confidence: 99%

Motor Evoked Potentials in Supratentorial Glioma Surgery

Grossauer¹,

Parpaley²,

Koeck³

2017

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Primary brain tumors, that is gliomas, are frequently located close to or within functional motor areas and motor tracts and therefore represent a major neurosurgical challenge. Preservation of the patients' motor functions, while achieving a maximum resection of tumor, can be only achieved by monitoring and locating motor areas and motor tracts intraoperatively. The intraoperative use of motor evoked potentials (MEPs) represents the current gold standard to do so. However, intraoperative MEP monitoring and mapping can be quite challenging and require a profound knowledge of the MEP technique, brain anatomy and physiology and anesthesia. In this chapter, a systematic review of PubMed listed literature on MEP monitoring and mapping in glioma surgery is presented. The beneits, limitations, technical pearls and pitfalls are discussed from the perspective of an experienced neurosurgical/neurophysiological team.

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Detection of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Using Motor Evoked Potentials

Abstract: VS following aSAH can be detected accurately by using MEPs. MEPs are a feasible bedside tool for online VS detection in an intensive care unit and, therefore, may complement existing diagnostic tools.

Cited by 5 publications

References 37 publications

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Motor Evoked Potentials in Supratentorial Glioma Surgery

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