Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: Intraoperative changes and postoperative outcome

Andrea Szelényi, David Langer, Karl Kothbauer, Adauri Bueno De Camargo, Eugene S. Flamm, Vedran Deletis

Research output: Contribution to journalArticle

127 Scopus citations

Abstract

Object. The authors in this study evaluated muscle motor evoked potentials (MMEPs) elicited by transcranial electrical stimulation (TES) and direct cortical stimulation as a means of monitoring during cerebral aneurysm surgery. The analysis focused on the value and frequencies of any intraoperative changes and their correlation to the postoperative motor status. Methods. One hundred nineteen patients undergoing surgery for 148 cerebral aneurysms were included in the study. Muscle motor evoked potentials were elicited by a train of five constant-current anodal stimuli with an individual pulse duration of 0.5 msec and a stimulation rate of 2 Hz. Stimulation intensity was up to 240 mA for TES and up to 33 mA for direct cortical stimulation. The MMEPs were continuously recorded from the abductor pollicis brevis and tibialis anterior muscles bilaterally and from the biceps brachii and extensor digitorum communis muscles contralateral to the surgical side. The motor status was evaluated immediately after surgery and 7 days later. In 97% of the patients MMEPs were recordable for continuous neurophysiological monitoring of the vascular territory of interest throughout the surgery. In 14 patients significant intraoperative MMEP changes occurred, resulting in a transient motor deficit in one patient and a permanent motor deficit in six. The permanent loss of MMEPs in three patients was followed by a permanent severe motor deficit in one patient and severe clinical deterioration in the other two. Conclusions. Data in this study demonstrated that MMEPs are a useful means of intraoperative neurophysiological monitoring of motor pathway integrity and predicting postoperative motor status. The intraoperative loss of MMEPs reliably predicts both severe and permanent postoperative motor deficits.

Original languageEnglish (US)
Pages (from-to)675-681
Number of pages7
JournalJournal of neurosurgery
Volume105
Issue number5
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

Keywords

  • Cerebral aneurysm
  • Direct cortical stimulation
  • Intraoperative monitoring
  • Motor evoked potential
  • Motor outcome
  • Transcranial electrical stimulation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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