Implementation of Intraoperative Neurophysiological Monitoring during Endovascular Procedures in the Central Nervous System

Abstract

Background and Objective: Intraoperative monitoring (IOM) has been used in different surgical disciplines since the 1980s. Nonetheless, regular routine use of IOM in interventional neuroradiology units has only been reported in a few centers. The aim of this study is to report our experience, 1 year after deciding to implement standardized IOM during endovascular treatment of vascular abnormalities of the central nervous system. Methods: Basic recordings included somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs). Corticobulbar motor-evoked potentials and flash-visual-evoked potentials were also recorded depending on the topography of the lesion. Intra-arterial provocative tests (PTs) with amobarbital and lidocaine were also performed. All patients except 1 were under total intravenous anesthesia. Clinical outcome was assessed prospectively and correlated with IOM events. Results: Twelve patients and 15 procedures were monitored during the inclusion period. Significant IOM events were detected during 3 of the 15 procedures (20%). We observed temporary MEP changes in 2 cases which resolved after interruption of the embolization or application of corrective measures, leaving no postoperative neurological deficits. In 1 case, persistent SEP and MEP deterioration was detected secondary to a frontal hematoma, resulting in mild sensory-motor deficit in the right upper extremity after the procedure. Overall, 12 PTs (4 spinal cord and 8 brain abnormalities) were performed using lidocaine and sodium amytal injections. One positive result occurred after the injection of lidocaine. No false negatives were detected. Conclusions: IOM may provide continuous real-time data about the functional status of eloquent areas and pathways of the central nervous system in patients under general anesthesia. It therefore allows us to detect early neurological damage in time to perform specific actions that may prevent irreversible neurological deficits.

Intraoperative Neuromonitoring for Cerebral Arteriovenous Malformation Embolization: A Propensity-Score Matched Retrospective Database Study

“…The general utility of IONM has been explored in other neurosurgical procedures, ranging from benefits observed in spinal tumors and thoracolumbar fixation, to no benefit or even detriment seen in anterior cervical discectomy and fusions, as well as in pediatric procedures [ 2 , 6 , 13 , 14 ]. However, the value of IONM has only been minimally explored and reported for endovascular procedures, much less for intracranial AVM embolization [ 6 , 15 ]. Particularly for AVMs, their comparatively low incidence combined with the complexity of both their pathology and surgical management likely contributes to the current lack of guidelines regarding IONM usage for their treatment [ 16 ].…”

Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms

“…In particular, intraoperative motor-evoked potential (MEP) is more sensitive than other modalities [5,6]. However, the use of MEP monitoring in neuroendovascular therapy has been limited; therefore, the discussion on its feasibility has been sparse [6][7][8][9].…”

Comparing the effect between continuous infusion and intermittent bolus of rocuronium for intraoperative neurophysiologic monitoring of neurointervention under general anesthesia

“…In this situation, the use of intraoperative neurophysiologic monitoring (IOM), including somatosensory evoked potential (SSEP) and motor evoked potentials (MEP) has become more common and is often considered a predictor of neurologic functional outcomes. [1,2]…”