Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery

Horton, Tristram G.; Barnes, M.; Johnson, S.; Kalapos, Paul; Link, Andreas; Cockroft, Kevin M.

doi:10.3174/ajnr.a3017

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…Although intraoperative neurophysiological monitoring to prevent ischemic complications should be used in endovascular treatment, it is uncommon. There are a few reports about the introduction of MEP monitoring in endovascular surgery for cerebral aneurysms, and they mostly suggested the feasibility of intraoperative MEP monitoring [6,9,26,27]. Our study also showed the feasibility of MEP monitoring in the endovascular treatment of AChA aneurysms.…”

Section: Discussionsupporting

confidence: 67%

“…In our study, 3 out of 11 patients (23%) showed MEP changes during the procedure. In contrast, only 1-4% of patients demonstrated MEP changes in the other three studies [6,26,27]. This difference appeared due to the difference in treated aneurysms; our study and Hiraishi's study included only AChA aneurysms.…”

Section: Discussioncontrasting

confidence: 61%

“…Currently, various methods are used to prevent ischemic complications during aneurysmal clipping. In particular, intraoperative motor-evoked potential (MEP) is more sensitive than other modalities [5,6]. However, the use of MEP monitoring in neuroendovascular therapy has been limited; therefore, the discussion on its feasibility has been sparse [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms

et al. 2021

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Purpose Intraoperative motor-evoked potential (MEP) monitoring is widely used in the neck clipping of cerebral aneurysms. Little is known regarding the usefulness of intraoperative MEP monitoring in endovascular aneurysm surgery. The purpose of this study was to validate the feasibility of intraoperative MEP monitoring during the coil embolization of anterior choroidal artery (AChA) aneurysms. Methods Clinical and angiographic data of consecutive patients who underwent coil embolization for unruptured AChA aneurysms with or without intraoperative MEP monitoring between January 2014 and December 2018 at our institute were abstracted and analyzed retrospectively. Results Twenty-three unruptured AChA aneurysms were treated. Eleven patients received MEP monitoring, and three of them experienced intraoperative reduction or disappearance of the MEP wave. Even during MEP changes, AChA filling showed no change in any of the three cases. Although one case with MEP monitoring encountered the disappearance of AChA filling, there was no change in MEP. This might be due to retrograde filling of the AChA from the anastomosis with the lateral posterior choroidal artery. AChA blood flow detected by angiography did not always reflect MEP status. When comparing the presence or absence of MEP monitoring, the volume embolization ratio of coiled aneurysms was significantly better in the MEP group. Conclusion Intraoperative MEP monitoring during endovascular coiling for AChA aneurysms may be feasible. AChA blood flow detected by angiography does not always reflect MEP status.

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Section: Discussionsupporting

confidence: 67%

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms

et al. 2021

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“…Therefore, even without MEP satisfying the warning criteria, IC can occur with abnormal SSEP findings only. Particularly, in the non-MCA territory, given the high likelihood of a false-negative MEP, care should be taken when interpreting the monitoring results (38,39). Although both the MEP and SSEP pathways are mainly distributed in the MCA territory, our risk factor analysis showed that UIA in the non-MCA territory was not a significant risk factor for IC.…”

Section: Discussionmentioning

confidence: 75%

Usefulness of Intraoperative Neurophysiological Monitoring During the Clipping of Unruptured Intracranial Aneurysm: Diagnostic Efficacy and Detailed Protocol

et al. 2021

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Background: Intraoperative neurophysiological monitoring (IONM) has been widely applied in brain vascular surgeries to reduce postoperative neurologic deficit (PND). This study aimed to investigate the effect of IONM during clipping of unruptured intracranial aneurysms (UIAs).Methods: Between January 2013 and August 2020, we enrolled 193 patients with 202 UIAs in the N group (clipping without IONM) and 319 patients with 343 UIAs in the M group (clipping with IONM). Patients in the M group were intraoperatively monitored for motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs). Irreversible evoked potential (EP) change was defined as EP deterioration that did not recover until surgery completion. Sustained PND was defined as neurological symptoms lasting for more than one postoperative month.Results: Ten (3.1%) and 13 (6.7%) in the M and N groups, respectively, presented with PND. Compared with the N group, the M group had significantly lower occurrence rates of sustained PND [odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.13–0.98, p = 0.04], ischemic complications (OR = 0.39, 95% CI = 0.15–0.98, p = 0.04), and radiologic complications (OR = 0.40, 95% CI = 0.19–0.82, p = 0.01). Temporary clipping was an independent risk factor for ischemic complications (ICs) in the total patient group (OR = 6.18, 95% CI = 1.75–21.83, p = 0.005), but not in the M group (OR = 5.53, 95% CI = 0.76–41.92, p = 0.09). Regarding PND prediction, considering any EP changes (MEP and/or SSEP) showed the best diagnostic efficiency with a sensitivity of 0.900, specificity of 0.940, positive predictive value of 0.321, negative predictive value (NPV) of 0.997, and a negative likelihood ratio (LR) of 0.11.Conclusion: IONM application during UIA clipping can reduce PND and radiological complications. The diagnostic effectiveness of IONM, specifically the NPV and LR negative values, was optimal upon consideration of changes in any EP modality.

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“…Neurophysiological monitoring with somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring has been applied during cerebrovascular surgery to detect functional motor and sensory disturbances (4)(5)(6)(7)(8). Recent studies have suggested that SSEP and MEP monitoring can reliably evaluate the ischemic status during endovascular aneurysm treatment and can improve clinical outcomes (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

et al. 2022

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IntroductionThe present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function.MethodsThis study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed.ResultsTreated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case.ConclusionAlthough significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.

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Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery

Cited by 14 publications

References 13 publications

Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms

Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms

Usefulness of Intraoperative Neurophysiological Monitoring During the Clipping of Unruptured Intracranial Aneurysm: Diagnostic Efficacy and Detailed Protocol

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

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