Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report

Andrea Szelényi, Adauri Bueno De Camargo, Eugene S. Flamm, Vedran Deletis

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

Original languageEnglish (US)
Pages (from-to)575-578
Number of pages4
JournalJournal of Neurosurgery
Volume99
Issue number3
StatePublished - Sep 1 2003
Externally publishedYes

Fingerprint

Motor Evoked Potentials
Hemiplegia
Aneurysm
Intraoperative Neurophysiological Monitoring
Efferent Pathways
Internal Capsule
Ischemia
Incidental Findings
Somatosensory Evoked Potentials
Middle Cerebral Artery
Intracranial Aneurysm
Surgical Instruments
Skeletal Muscle
Extremities
Tomography

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report. / Szelényi, Andrea; De Camargo, Adauri Bueno; Flamm, Eugene S.; Deletis, Vedran.

In: Journal of Neurosurgery, Vol. 99, No. 3, 01.09.2003, p. 575-578.

Research output: Contribution to journalArticle

Szelényi, Andrea ; De Camargo, Adauri Bueno ; Flamm, Eugene S. ; Deletis, Vedran. / Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report. In: Journal of Neurosurgery. 2003 ; Vol. 99, No. 3. pp. 575-578.
@article{aad1f4d51128422f831b2bbf9ecdec85,
title = "Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report",
abstract = "The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.",
keywords = "Cerebral aneurysm, Direct cortical stimulation, Intraoperative monitoring, Motor evoked potential, Transcranial electrical stimulation",
author = "Andrea Szel{\'e}nyi and {De Camargo}, {Adauri Bueno} and Flamm, {Eugene S.} and Vedran Deletis",
year = "2003",
month = "9",
day = "1",
language = "English (US)",
volume = "99",
pages = "575--578",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report

AU - Szelényi, Andrea

AU - De Camargo, Adauri Bueno

AU - Flamm, Eugene S.

AU - Deletis, Vedran

PY - 2003/9/1

Y1 - 2003/9/1

N2 - The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

AB - The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.

KW - Cerebral aneurysm

KW - Direct cortical stimulation

KW - Intraoperative monitoring

KW - Motor evoked potential

KW - Transcranial electrical stimulation

UR - http://www.scopus.com/inward/record.url?scp=0042421960&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0042421960&partnerID=8YFLogxK

M3 - Article

C2 - 12959448

AN - SCOPUS:0042421960

VL - 99

SP - 575

EP - 578

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 3

ER -