86. Intraoperative monitoring in brain aneurysms surgery

• Published in: Clinical neurophysiology 2013-11, Vol.124 (11), p.e208-e208
• Main Authors: Costa, P, Benech, C.A, Marmolino, S, Giobbe, L, Ciaramitaro, P, Boido, B, Faccani, G
• Format: Article
• Language: English
• Subjects: Neurology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2013.06.113

Persistent neurologic sequelae may be the consequences of brain aneurysms surgery. Aim of this study is to test the role of intraoperative neurophysiology in the prevention of postoperative deficits. Combined monitoring of combined m-MEPs and SEPs was attempted in 164 consecutive surgeries on 158 patients undergoing surgery for the treatment of 173 aneurisms. In 90 surgeries (54.9%) patients have suffered for SAH; 74 (54.1%) surgeries were performed for unrupted aneurysms. In 12 cases (7.3%), all of them affected by SAH, intraoperative neurophysiology documented a severe damage to motor or sensory/motor pathways: the overall monitorability was 92.7% (152 surgeries). Intraoperative modifications of neurophysiologic parameters were observed in 28 (18.4%) of the remaining 124 cases, transient in 17 (11.2%) and persistent in 11 (7.2%). Combined modifications of SEPs and m-MEPs (a pattern of cortical ischemia) were observed in 10 cases (reversible in 4, persistent in 6), isolated modifications of m-MEPs in 16 cases (11 transient, 5 persistent). In 2 cases a transient reduction in amplitude of SEPs was seen. All but one of cases with persistent modifications were followed by postoperative deficits. Intraoperative neurophysiology may detect an impending injury particularly on motor pathways and provide relevant information about sensory/motor outcome.