The primary application of intra-operative evoked potentials monitoring in microsurgery of intracranial aneurysms / 中国神经精神疾病杂志

ABSTRACT

Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.