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

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

Research output: Contribution to journalArticle

41 Scopus citations

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
DOIs
StatePublished - Sep 1 2003
Externally publishedYes

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Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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