Motor evoked potential monitoring during cerebral aneurysm surgery

Technical aspects and comparison of transcranial and direct cortical stimulation

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

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

OBJECTIVE: This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. METHODS: In 119 patients undergoing cerebral aneurysm surgery, mMEPs were evoked by a train of five stimuli with individual pulse duration of 0.5 milliseconds, a repetition rate of 2 Hz, and constant current anodal stimulation. The maximal stimulation intensity was 240 mA for transcranial and 33 mA for direct stimulation. mMEPs were recorded continuously from the abductor pollicis brevis, from tibial anterior muscles bilaterally, and from the biceps brachii and extensor digitorum communis muscles contralateral to the side operated on. RESULTS: In 118 (99%) of 119 patients, transcranially evoked mMEPs were monitorable for the viscular territory of interest. DCS was performed successfully in 95 (95%) of 100 patients. In 86 (99%) of 87 patients with internal carotid artery, middle cerebral artery, or posterior circulation aneurysms, mMEPs from upper-extremity muscles were obtained with DCS. In 11 (55%) of 20 patients with anterior communicating artery, anterior cerebral artery, or pericallosal aneurysms, mMEPs from the lower-extremity muscles could be recorded. The incidence of seizures was 0.84% for TES and 1% for DCS. Minor and inconsequential subdural bleeding after positioning of the strip electrode occurred in 2%. CONCLUSION: The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99% of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.

Original languageEnglish (US)
JournalNeurosurgery
Volume57
Issue number4 SUPPL.
DOIs
StatePublished - Oct 2005

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Motor Evoked Potentials
Intracranial Aneurysm
Muscles
Aneurysm
Electrodes
Anterior Cerebral Artery
Middle Cerebral Artery
Internal Carotid Artery
Upper Extremity
Electric Stimulation
Blood Vessels
Lower Extremity
Skeletal Muscle
Seizures
Arteries
Hemorrhage
Safety

Keywords

  • Cerebral aneurysm surgery
  • Direct cortical stimulation
  • Intraoperative monitoring
  • Intraoperative seizure
  • Motor evoked potentials
  • Safety
  • Transcranial electric stimulation

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Motor evoked potential monitoring during cerebral aneurysm surgery : Technical aspects and comparison of transcranial and direct cortical stimulation. / Szelényi, Andrea; Kothbauer, Karl; De Camargo, Adauri Bueno; Langer, David; Flamm, Eugene S.; Deletis, Vedran.

In: Neurosurgery, Vol. 57, No. 4 SUPPL., 10.2005.

Research output: Contribution to journalArticle

Szelényi, Andrea ; Kothbauer, Karl ; De Camargo, Adauri Bueno ; Langer, David ; Flamm, Eugene S. ; Deletis, Vedran. / Motor evoked potential monitoring during cerebral aneurysm surgery : Technical aspects and comparison of transcranial and direct cortical stimulation. In: Neurosurgery. 2005 ; Vol. 57, No. 4 SUPPL.
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abstract = "OBJECTIVE: This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. METHODS: In 119 patients undergoing cerebral aneurysm surgery, mMEPs were evoked by a train of five stimuli with individual pulse duration of 0.5 milliseconds, a repetition rate of 2 Hz, and constant current anodal stimulation. The maximal stimulation intensity was 240 mA for transcranial and 33 mA for direct stimulation. mMEPs were recorded continuously from the abductor pollicis brevis, from tibial anterior muscles bilaterally, and from the biceps brachii and extensor digitorum communis muscles contralateral to the side operated on. RESULTS: In 118 (99{\%}) of 119 patients, transcranially evoked mMEPs were monitorable for the viscular territory of interest. DCS was performed successfully in 95 (95{\%}) of 100 patients. In 86 (99{\%}) of 87 patients with internal carotid artery, middle cerebral artery, or posterior circulation aneurysms, mMEPs from upper-extremity muscles were obtained with DCS. In 11 (55{\%}) of 20 patients with anterior communicating artery, anterior cerebral artery, or pericallosal aneurysms, mMEPs from the lower-extremity muscles could be recorded. The incidence of seizures was 0.84{\%} for TES and 1{\%} for DCS. Minor and inconsequential subdural bleeding after positioning of the strip electrode occurred in 2{\%}. CONCLUSION: The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99{\%} of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.",
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T2 - Technical aspects and comparison of transcranial and direct cortical stimulation

AU - Szelényi, Andrea

AU - Kothbauer, Karl

AU - De Camargo, Adauri Bueno

AU - Langer, David

AU - Flamm, Eugene S.

AU - Deletis, Vedran

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N2 - OBJECTIVE: This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. METHODS: In 119 patients undergoing cerebral aneurysm surgery, mMEPs were evoked by a train of five stimuli with individual pulse duration of 0.5 milliseconds, a repetition rate of 2 Hz, and constant current anodal stimulation. The maximal stimulation intensity was 240 mA for transcranial and 33 mA for direct stimulation. mMEPs were recorded continuously from the abductor pollicis brevis, from tibial anterior muscles bilaterally, and from the biceps brachii and extensor digitorum communis muscles contralateral to the side operated on. RESULTS: In 118 (99%) of 119 patients, transcranially evoked mMEPs were monitorable for the viscular territory of interest. DCS was performed successfully in 95 (95%) of 100 patients. In 86 (99%) of 87 patients with internal carotid artery, middle cerebral artery, or posterior circulation aneurysms, mMEPs from upper-extremity muscles were obtained with DCS. In 11 (55%) of 20 patients with anterior communicating artery, anterior cerebral artery, or pericallosal aneurysms, mMEPs from the lower-extremity muscles could be recorded. The incidence of seizures was 0.84% for TES and 1% for DCS. Minor and inconsequential subdural bleeding after positioning of the strip electrode occurred in 2%. CONCLUSION: The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99% of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.

AB - OBJECTIVE: This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. METHODS: In 119 patients undergoing cerebral aneurysm surgery, mMEPs were evoked by a train of five stimuli with individual pulse duration of 0.5 milliseconds, a repetition rate of 2 Hz, and constant current anodal stimulation. The maximal stimulation intensity was 240 mA for transcranial and 33 mA for direct stimulation. mMEPs were recorded continuously from the abductor pollicis brevis, from tibial anterior muscles bilaterally, and from the biceps brachii and extensor digitorum communis muscles contralateral to the side operated on. RESULTS: In 118 (99%) of 119 patients, transcranially evoked mMEPs were monitorable for the viscular territory of interest. DCS was performed successfully in 95 (95%) of 100 patients. In 86 (99%) of 87 patients with internal carotid artery, middle cerebral artery, or posterior circulation aneurysms, mMEPs from upper-extremity muscles were obtained with DCS. In 11 (55%) of 20 patients with anterior communicating artery, anterior cerebral artery, or pericallosal aneurysms, mMEPs from the lower-extremity muscles could be recorded. The incidence of seizures was 0.84% for TES and 1% for DCS. Minor and inconsequential subdural bleeding after positioning of the strip electrode occurred in 2%. CONCLUSION: The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99% of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.

KW - Cerebral aneurysm surgery

KW - Direct cortical stimulation

KW - Intraoperative monitoring

KW - Intraoperative seizure

KW - Motor evoked potentials

KW - Safety

KW - Transcranial electric stimulation

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