Effects ofTemporary Clips on Somatosensory Evoked Potentials in Aneurysm Surgery

Abstract

There is no genuinely safe permissible occlusion time. Despite complete recovery of SEPs after a loss of potential, the patient may develop new deficits.

The Diagnostic Accuracy of Evoked Potential Monitoring Techniques During Intracranial Aneurysm Surgery for Predicting Postoperative Ischemic Damage: A Systematic Review and Meta-Analysis

“…Fourteen of these studies met the inclusion criteria ( Fig. 1) 11,12,14,15,24,26,[35][36][37][38][39][41][42][43] . They include 1597 patients (95% CI: 276, 2881) with a total of 1689 (336, 3042) aneurysms; 1556 (92.0%) aneurysms in the anterior circulation and 134 (8.0%) in the posterior circulation.…”

“…Tables 1, 2 and 3 summarise the characteristics of the eight studies 11,14,24,26,35,37,38,43 that used SSEP as the index test, six studies that used TcMEP 11,15,24,39,41,42 , and five that used DMEP 12,14,15,36,41 , respectively. Two studies 11,24 employed both SSEP and TcMEP monitoring techniques as the index test, two 15,41 used TcMEP and DMEP, and none of the studies measured both SSEP and DMEP.…”

“…All fourteen studies used a >50% increase in amplitude as the diagnostic criteria for significant change in evoked potential monitoring. Four 11,24,26,37 of the eight studies in the SSEP group also used a >10% increase in latency while three also used prolonged CCT by 25% 35,38 and 1 msec 43 . One study 14 in the SSEP group used a >50% decrease in amplitude as the only diagnostic criteria for significant change in evoked potential monitoring.…”

“…The two studies used halogenated inhalational anaesthesia and nitrous oxide (NO 2 ) in the maintenance phase of anaesthesia, and three studies 11,24,38 used both TIVA and low concentrations of halogenated inhalational anaesthesia. Two 14,37 in the same group used TIVA as the only method of anaesthesia in the maintenance phase while one study 26 used TIVA and thiopental. The TcMEP group had three studies 11,24,41 that used both TIVA and inhalational anaesthesia while the other three 15,39,42 used TIVA alone.…”

“…Ischaemic brain injury is a major complication during intracranial aneurysm surgery. It occurs as a result of reduced cerebral blood flow 14 associated with various surgical manoeuvres 25,26,27 , physiological conditions, anaesthesia, and postsurgical complications 19,20,11,21,22 . Surgical manoeuvres leading to blood flow disturbance includes aneurysmal neck clipping, temporary occlusion of a parent artery, and direct injury to perforating arteries, retraction, and clip rotations.…”