Multiple Intraoperative Monitoring-Assisted Microneurosurgical Treatment for Anterior Circulation Cerebral Aneurysm

Abstract

Postoperative motor deficits were observed in three patients, two of which were Glasgow Outcome Scale level 3 (4.4%). In conclusion, for patients with anterior circulation cerebral aneurysm (H&H grade < 3), multiple intraoperative monitoring was beneficial for finding residual aneurysms, detecting ischaemic events in the perforating arteries and reducing severe postoperative motor deficiency.

Predictive value of motor evoked potential monitoring during surgery of unruptured anterior circulation cerebral aneurysms

“…Multimodality intraoperative monitoring has helped the surgeons to improve the outcome of the aneurysm patients. [ 1 ] Based on the results of intraoperative ICG-VA, endoscopy, and MEP monitoring, the surgeon may decide to change his/her strategy of clipping. [ 1 7 ] Despite all the monitoring techniques, a postoperative morbidity is always a real threat which might be explained by distal emboli during vascular manipulation, brain infarction or ischemia due to proximal closure, or damage to the perforating arteries by the temporary or permanent clips.…”

“…[ 1 ] Based on the results of intraoperative ICG-VA, endoscopy, and MEP monitoring, the surgeon may decide to change his/her strategy of clipping. [ 1 7 ] Despite all the monitoring techniques, a postoperative morbidity is always a real threat which might be explained by distal emboli during vascular manipulation, brain infarction or ischemia due to proximal closure, or damage to the perforating arteries by the temporary or permanent clips. With the addition of MEP, we try to discover some of these subtle changes intraoperatively though we are still not sure if their discovery and timely treatment will improve the outcome.…”

“…Multimodality monitoring during aneurysm surgery has improved surgical outcome in the last decades. [ 1 2 ] Indocyanine green (ICG) videoangiography (VA), intraoperative conventional angiography, neuroendoscopy, Doppler ultrasound, and electrophysiologic monitoring have all been described to check for anatomical or functional abnormalities during the surgery and reduce any possible postoperative complication. [ 3 4 ] There are some case series considering some role for motor evoked potential (MEP) monitoring during the surgery and its correlation with the postoperative outcome.…”

Intraoperative Somatosensory and Motor Evoked Potential Recording and Electroencephalographic Monitoring Usefulness During Aneurysm Surgery

“…SSEPs changes in a target cerebral artery area in unsafe conditions, like critical brain retraction, mechanical vasospasm, temporary occlusion, troubles in perforating vessels, and low aneurysms clipping, may help neurosurgeons to adapt surgical strategy and avoid ischaemic damage [20,98,99].…”

“…On the other hand, literature reports a false negative rate up to 25% [100][101][102] about new postoperative motor deficit incidence in SSEP monitoring, suggesting that combined SSEP and MEP intraoperative monitoring is superior to SSEP monitoring alone in predicting ischaemic events caused by blood flow of some perforating arteries disturbance [99,[103][104][105][106].…”