Advertisement

A prediction of postoperative neurological deficits following intracranial aneurysm surgery using somatosensory evoked potential deterioration duration

  • Mingran Wang
  • Zhibao Li
  • Xing Fan
  • Xiaorong Tao
  • Lei Qi
  • Miao Ling
  • Dongze Guo
  • Hui Qiao
Original Article
  • 10 Downloads

Abstract

Although the application of somatosensory evoked potential (SSEP) in intracranial aneurysm surgery has been well demonstrated, the relationship between the duration of SSEP deterioration and postoperative neurological deficits (PNDs) is still not clear. The objectives of this study were (1) to detect the relationship between the SSEP deterioration duration and PND; and (2) detect the relationship between SSEP deterioration duration and postoperative computed tomography (CT) findings. Data from 587 patients were reviewed and 40 patients with SSEP deterioration were enrolled. Four patients presented irreversible disappearance and 36 patients presented reversible deterioration (including 9 [25%] patients with reversible reduction and 27 [75%] patients with reversible disappearance). In the patients with reversible SSEP deterioration, 17 patients had PNDs, and the SSEP deterioration duration was 42 ± 46 min, ranging from 5 to 180 min. Nineteen patients did not have PNDs, and their duration of SSEP deterioration was 11 ± 9 min (range 2–40 min). The SSEP deterioration duration significantly differed between patients with or without PND (P < 0.01). Eleven minutes is the optimal cut-off value of motor evoked potential change duration avoiding PND (area under the curve = 0.84). Patients with a SSEP deteriorating duration > 11 min had a significant higher incidence rate of abnormal CT finding postoperatively (p < 0.05). According to these results, we conclude that the duration of SSEP deterioration is extremely important to postoperative neurological function, and in order to avoid PND, the SSEP deterioration duration must not exceed 10 min. The SSEP deterioration duration is also associated with postoperative CT findings.

Keywords

Aneurysm SSEP monitoring Duration of SSEP deterioration Intraoperative monitoring Postoperative neurological deficit 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The current study was approved by the ethical committee of our hospital.

Informed consent

Informed consent was obtained for all enrolled patients.

References

  1. 1.
    Branston NM, Symon L, Crockard HA, Pasztor E (1974) Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45:195–208CrossRefGoogle Scholar
  2. 2.
    Branston NM, Strong AJ, Symon L (1977) Extracellular potassium activity, evoked potential and tissue blood flow. Relationships during progressive ischaemia in baboon cerebral cortex. J Neurol Sci 32:305–321CrossRefGoogle Scholar
  3. 3.
    Branston NM, Ladds A, Symon L, Wang AD (1984) Comparison of the effects of ischaemia on early components of the somatosensory evoked potential in brainstem, thalamus, and cerebral cortex. J Cereb Blood Flow Metab 4:68–81.  https://doi.org/10.1038/jcbfm.1984.9 CrossRefGoogle Scholar
  4. 4.
    Charbel FT, Ausman JI, Diaz FG, Malik GM, Dujovny M, Sanders J (1991) Temporary clipping in aneurysm surgery: technique and results. Surg Neurol 36:83–90CrossRefGoogle Scholar
  5. 5.
    Ducati A, Landi A, Cenzato M, Fava E, Rampini P, Giovanelli M, Villani R (1988) Monitoring of brain function by means of evoked potentials in cerebral aneurysm surgery. Acta Neurochir Suppl (Wien) 42:8–13Google Scholar
  6. 6.
    Friedman WA, Kaplan BL, Day AL, Sypert GW, Curran MT (1987) Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:678–687CrossRefGoogle Scholar
  7. 7.
    Friedman WA, Chadwick GM, Verhoeven FJ, Mahla M, Day AL (1991) Monitoring of somatosensory evoked potentials during surgery for middle cerebral artery aneurysms. Neurosurgery 29:83–88CrossRefGoogle Scholar
  8. 8.
    Jabre A, Symon L (1987) Temporary vascular occlusion during aneurysm surgery. Surg Neurol 27:47–63CrossRefGoogle Scholar
  9. 9.
    Ljunggren B, Saveland H, Brandt L, Kagstrom E, Rehncrona S, Nilsson PE (1983) Temporary clipping during early operation for ruptured aneurysm: preliminary report. Neurosurgery 12:525–530CrossRefGoogle Scholar
  10. 10.
    Lopez JR (2004) The use of evoked potentials in intraoperative neurophysiologic monitoring. Phys Med Rehabil Clin N Am 15:63–84CrossRefGoogle Scholar
  11. 11.
    Mizoi K, Yoshimoto T (1993) Permissible temporary occlusion time in aneurysm surgery as evaluated by evoked potential monitoring. Neurosurgery 33:434–440 discussion 440Google Scholar
  12. 12.
    Nash CL, Jr., Lorig RA, Schatzinger LA, Brown RH (1977) Spinal cord monitoring during operative treatment of the spine. Clin Orthop Relat Res NA 126:100–105Google Scholar
  13. 13.
    Ogawa A, Sato H, Sakurai Y, Yoshimoto T (1991) Limitation of temporary vascular occlusion during aneurysm surgery. Study by intraoperative monitoring of cortical blood flow. Surg Neurol 36:453–457CrossRefGoogle Scholar
  14. 14.
    Samson D, Batjer HH, Bowman G, Mootz L, Krippner WJ Jr, Meyer YJ, Allen BC (1994) A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms. Neurosurgery 34:22–28 discussion 28-29Google Scholar
  15. 15.
    Schick U, Dohnert J, Meyer JJ, Vitzthum HE (2005) Effects of temporary clips on somatosensory evoked potentials in aneurysm surgery. Neurocrit Care 2:141–149.  https://doi.org/10.1385/NCC:2:2:141 CrossRefGoogle Scholar
  16. 16.
    Symon L (1980) The relationship between CBF, evoked potentials and the clinical features in cerebral ischaemia. Acta Neurol Scand Suppl 78:175–190Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neuroelectrophysiology Room of Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
  2. 2.Beijing Neurosurgical InstituteCapital Medical University Beijing Tiantan HospitalBeijingChina

Personalised recommendations