Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms

Abstract

Blood flow insufficiency in both the LSA and MCA cortical branches that perfuse the corticospinal tract can be detected by intraoperative MEP monitoring. Somatosensory evoked potential monitoring is not reliable enough to detect BFI in the MCA branches and the LSAs.

The Incidence of Unacceptable Movement with Motor Evoked Potentials During Craniotomy for Aneurysm Clipping

“…In up to 25% of cases in which a new postoperative deficit (mostly paresis) manifests, there were unaltered intraoperative SEP recordings; this is likely because the motor pathways derive some blood supply from arteries that are anatomically distinct from arteries supplying sensory cortical pathways (20). In addition, likely owing to differences in the amount of collateral circulation to the vulnerable area, MEP monitoring can give relatively early warning of potential ischemic injury (8,9).…”

Detección de episodios de hipoxia tisular isquémica mediante la monitorización neurofisiológica intraoperatoria combinada con la monitorización de la oxigenación tisular en la cirugía aneurismática

“…Tanto en modelos de experimentación animal como en la literatura neuroquirúrgica, se ha establecido la relación existente entre los cambios en la monitorización neurofisiológica y los cambios regionales del flujo sanguíneo cerebral 2,[5][6][7][8][9][10][11]15,[20][21][22]27,28,[39][40][41][42]47 . Cabe destacar también, que en los últimos años se está extendiendo el uso de los potenciales evocados motores dentro de las técnicas de monitorización neurofisiológica intraoperatoria, ya que éstos han demostrado tener una elevada sensibilidad en la detección de fenómenos isquémicos en la cirugía aneurísmática 23,34,45 . Nosotros en nuestro caso, dada la disponibilidad en nuestro centro, aplicamos única-mente la monitorización de los PESS y PEATC.…”

Recording of Corticospinal Evoked Potential for Optimum Placement of Motor Cortex Stimulation Electrodes in the Treatment of Post-stroke Pain -Two Case Reports-

“…The recording electrode can be easily and safely placed in the epidural space by the same technique as used for transcutaneous spinal cord stimulation for the treatment of pain, and we have already Monitoring of the muscle responses to direct motor cortex stimulation is also useful for the monitoring of cerebral ischemia. 6) Another advantage is that, unlike muscle responses to motor cortex stimulation, the D-wave of the corticospinal MEP is resistant to surgical doses of anesthetics and is unaffected by muscle relaxants, apart from changes to the excitability of the spinal motor neurons, and so the amplitude can be easily correlated with the site of cortical stimulation. The present study indicates that monitoring of the D-wave provides a good indicator of the optimum placement of the chronic electrode for the treatment of post-stroke pain, and thus allows implantation of the motor cortex stimulation electrode in a one-stage operation under general anesthesia.…”