Neurophysiological Monitoring in the Endovascular Therapy of Aneurysms

• Published in: American journal of neuroradiology : AJNR Vol. 24; no. 8; pp. 1520 - 1527
• Main Authors: Liu, Amon Y, Lopez, Jaime R, Do, Huy M, Steinberg, Gary K, Cockroft, Kevin, Marks, Michael P
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.09.2003; American Society of Neuroradiology
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - physiopathology; Aneurysm, Ruptured - therapy; Balloon Occlusion; Biological and medical sciences; Brain - physiopathology; Brain Ischemia - diagnosis; Brain Ischemia - physiopathology; Brain Ischemia - prevention & control; Electroencephalography; Embolization, Therapeutic - adverse effects; Evoked Potentials, Auditory, Brain Stem - physiology; Evoked Potentials, Somatosensory - physiology; Female; Humans; Interventional; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - therapy; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - physiopathology; Ischemic Attack, Transient - prevention & control; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Neurology; Retrospective Studies; Risk Assessment; Vascular diseases and vascular malformations of the nervous system; Human; Intracranial; Nervous system diseases; Brain stem; Aneurysm; Instrumentation therapy; Cuffed tube; Cardiovascular disease; Exploration; Intraoperative; Instrumental dilatation; Electroencephalography; Cerebral disorder; Encephalon; Vascular disease; Electrodiagnosis; Ischemia; Auditory evoked potential; Central nervous system disease; Embolization; Somatosensory evoked potential; Cerebrovascular disease
• ISSN: 0195-6108; 1936-959X

Endovascular aneurysm therapy has associated risks of ischemic complications. We undertook this study to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms. Thirty-five patients underwent NPM during endovascular treatment of cerebral aneurysms. The patients underwent a total of 50 endovascular procedures, including balloon test occlusion (19 patients), GDC embolization (22 patients), and permanent vessel occlusion (nine patients). NPM included electroencephalography, somatosensory evoked potentials, and/or brain stem auditory evoked potentials, depending on the location of the aneurysm. NPM changes were seen in nine (26%) of 35 patients and altered the management in five (14%) of 35 patients. In three of the five cases, NPM changes were observed without corresponding neurologic physical examination changes after balloon test occlusion (performed while the patients were under general anesthesia in two cases). In the two other cases in which NPM changes altered management, ischemia was detected at the time of intra-aneurysmal therapy while the patients were under general anesthesia. Overall, 18 of 35 patients underwent a total of 19 balloon test occlusion procedures. Of the 17 remaining patients, 13 underwent aneurysm coiling, two were not treated because of inability to safely place coils, and two were treated for distal aneurysms. Two patients developed transient neurologic deficits without concurrent NPM changes, representing false-negative NPM test results. NPM is a valuable adjunct to endovascular treatment of cerebral aneurysms. Our study suggests that these monitoring techniques may reduce ischemic complications and can be used to help guide therapeutic decisions.