Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery: Technique Application for 30 Consecutive Patients

Alfredo Quinones-Hinojosa, Mirza Alam, Russ Lyon, Charles D. Yingling, Michael T. Lawton, Jeffrey D. Klopfenstein, Robert F. Spetzler, Patrick J. Kelly, Robert A. Solomon

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVE: Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring. METHODS: Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients. RESULTS: All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33%), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P < 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken. CONCLUSION: TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.

Original languageEnglish (US)
Pages (from-to)916-924
Number of pages9
JournalNeurosurgery
Volume54
Issue number4
StatePublished - Apr 2004
Externally publishedYes

Fingerprint

Motor Evoked Potentials
Intracranial Aneurysm
Somatosensory Evoked Potentials
Ischemia
Neurophysiological Monitoring
Arteries
Intraoperative Monitoring
Temporal Arteries
Basilar Artery
Craniotomy
Mesencephalon

Keywords

  • Aneurysm
  • Basilar artery
  • Motor evoked potential
  • Neuromonitoring
  • Somatosensory evoked potential
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Quinones-Hinojosa, A., Alam, M., Lyon, R., Yingling, C. D., Lawton, M. T., Klopfenstein, J. D., ... Solomon, R. A. (2004). Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery: Technique Application for 30 Consecutive Patients. Neurosurgery, 54(4), 916-924.

Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery : Technique Application for 30 Consecutive Patients. / Quinones-Hinojosa, Alfredo; Alam, Mirza; Lyon, Russ; Yingling, Charles D.; Lawton, Michael T.; Klopfenstein, Jeffrey D.; Spetzler, Robert F.; Kelly, Patrick J.; Solomon, Robert A.

In: Neurosurgery, Vol. 54, No. 4, 04.2004, p. 916-924.

Research output: Contribution to journalArticle

Quinones-Hinojosa, A, Alam, M, Lyon, R, Yingling, CD, Lawton, MT, Klopfenstein, JD, Spetzler, RF, Kelly, PJ & Solomon, RA 2004, 'Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery: Technique Application for 30 Consecutive Patients', Neurosurgery, vol. 54, no. 4, pp. 916-924.
Quinones-Hinojosa, Alfredo ; Alam, Mirza ; Lyon, Russ ; Yingling, Charles D. ; Lawton, Michael T. ; Klopfenstein, Jeffrey D. ; Spetzler, Robert F. ; Kelly, Patrick J. ; Solomon, Robert A. / Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery : Technique Application for 30 Consecutive Patients. In: Neurosurgery. 2004 ; Vol. 54, No. 4. pp. 916-924.
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abstract = "OBJECTIVE: Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring. METHODS: Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients. RESULTS: All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33{\%}), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P < 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken. CONCLUSION: TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.",
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T2 - Technique Application for 30 Consecutive Patients

AU - Quinones-Hinojosa, Alfredo

AU - Alam, Mirza

AU - Lyon, Russ

AU - Yingling, Charles D.

AU - Lawton, Michael T.

AU - Klopfenstein, Jeffrey D.

AU - Spetzler, Robert F.

AU - Kelly, Patrick J.

AU - Solomon, Robert A.

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N2 - OBJECTIVE: Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring. METHODS: Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients. RESULTS: All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33%), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P < 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken. CONCLUSION: TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.

AB - OBJECTIVE: Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring. METHODS: Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients. RESULTS: All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33%), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P < 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken. CONCLUSION: TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.

KW - Aneurysm

KW - Basilar artery

KW - Motor evoked potential

KW - Neuromonitoring

KW - Somatosensory evoked potential

KW - Subarachnoid hemorrhage

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