ABSTRACT
BACKGROUND AND PURPOSE: Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures. MATERIALS AND METHODS: We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events. RESULTS: Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits. CONCLUSIONS: These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.
Subject(s)
Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/surgery , Evoked Potentials, Motor , Monitoring, Intraoperative/methods , Neurosurgical Procedures/methods , Vascular Surgical Procedures/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Feasibility Studies , Female , Humans , Male , Middle Aged , Treatment Outcome , Young AdultSubject(s)
Carcinoma, Small Cell/complications , Deafness/etiology , Lung Neoplasms/complications , Muscle Weakness/etiology , Paraneoplastic Syndromes, Nervous System/physiopathology , Vertigo/etiology , Brain/pathology , Carcinoma, Small Cell/pathology , Diagnosis, Differential , Female , Humans , Lung Neoplasms/pathology , Magnetic Resonance Imaging , Middle Aged , Paraneoplastic Syndromes, Nervous System/pathology , Spinal Cord/pathologyABSTRACT
BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.
Subject(s)
Angioplasty, Balloon/adverse effects , Carotid Stenosis/therapy , Intracranial Hemorrhages/etiology , Stents/adverse effects , Aged , Aged, 80 and over , Angiography , Carotid Stenosis/diagnostic imaging , Female , Humans , Intracranial Hemorrhages/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
A series of 50 postmediastinoscopy erect portable films was reviewed and compared with 100 normal control films to determine how often changes might develop after mediastinoscopy that could simulate mediastinal adenopathy. Such findings were found in 54% of postmediastinoscopy patients; they consisted of a thickened right paratracheal stripe (RPS) in 30%, a right paratracheal mass in 22%, and a left superior mediastinal mass in 4%. These changes usually resolve in a few days, but they may cause an initial erroneous impression of mediastinal adenopathy if recent previous films are not available for comparison. An indistinct RPS without a right paratracheal mass was found in 47% of control erect portable radiographs and was not considered a relevant finding.
