Use of intraoperative monitoring of somatosensory evoked potentials to prevent ischaemic stroke after surgical exclusion of middle cerebral artery aneurysms

Abstract Somatosensory evoked potentials (SEPs) were monitored during 53 procedures for aneurysms of the middle cerebral artery (MCA). “Significant” changes were reported to the surgeon, who took corrective action when possible. Changes in the SEPs were categorized as follows: Type I, no change; Type II, significant change with complete return to baseline; Type III, significant change with incomplete return to baseline; Type IV, complete loss with no return; and Type V, no response at baseline. Only 1 of 37 patients with a Type I SEP had a new neurological deficit, and this was a patient who could not be examined for several days after surgery because he was in a pentobarbital coma. All 4 patients with Type III and IV changes had new postoperative neurological deficits. Perhaps of greater importance, 4 of 5 patients with Type II changes had no new deficit. These patients all had changes in SEPs that were completely reversible by clip adjustment (2), prompt removal of temporary clips (1), and inducing hypertension after aneurysm trapping (1). These cases may, therefore, represent instances in which SEP monitoring allowed the clinicians to prevent a neurological deficit. The MCA supplies the area of the somatosensory cortex that controls the hand. Median nerve SEPs are, therefore, a theoretically ideal monitor during surgery for MCA aneurysms. This study suggests that the results of MCA aneurysm surgery may be accurately predicted and improved with SEP monitoring. (Neurosurgery 29:83-88, 1991)

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Monitoring of Cortical Somatosensory Evoked Potentials to Determine the Safety of Sacrificing the Anterior Cerebral Artery

Neurosurgery ◽

10.1227/00006123-198207010-00014 ◽

1982 ◽

Vol 11 (1_pt_1) ◽

pp. 64-67 ◽

Cited By ~ 28

Author(s):

Betty L. Grundy ◽

Paul B. Nelson ◽

Agnes Lina ◽

Roberto C. Heros

Keyword(s):

Arteriovenous Malformation ◽

Evoked Potentials ◽

Cerebral Artery ◽

Somatosensory Evoked Potentials ◽

Intraoperative Monitoring ◽

Anterior Cerebral Artery ◽

Sensorimotor Function ◽

Left Lower Extremity ◽

The Right ◽

Site Of Stimulation

Abstract Cortical somatosensory evoked potentials (SSEPs) reflect the functional integrity of somatosensory pathways from the site of stimulation to the primary somatosensory cortex. We used intraoperative monitoring of cortical SSEPs to determine whether the right anterior cerebral artery (RACA), the major feeding vessel of a large arteriovenous malformation (AVM), could be sacrificed without compromising sensorimotor function in the left lower extremity. The SSEPs recorded after test occlusion of the RACA showed preservation of the initial cortical positivity, and the RACA was divided. The AVM was excised completely, and the patient suffered no neurological deficit.

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Correlation between somatosensory evoked potentials and neuronal ischemic changes following middle cerebral artery occlusion.

Stroke ◽

10.1161/01.str.17.6.1193 ◽

1986 ◽

Vol 17 (6) ◽

pp. 1193-1197 ◽

Cited By ~ 20

Author(s):

G K Steinberg ◽

A W Gelb ◽

A M Lam ◽

P H Manninen ◽

S J Peerless ◽

...

Keyword(s):

Evoked Potentials ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Somatosensory Evoked Potentials ◽

Artery Occlusion ◽

Cerebral Artery Occlusion

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Somatosensory evoked potentials in rat cerebral cortex before and after middle cerebral artery occlusion.

Stroke ◽

10.1161/01.str.21.1.124 ◽

1990 ◽

Vol 21 (1) ◽

pp. 124-132 ◽

Cited By ~ 63

Author(s):

K Sakatani ◽

H Iizuka ◽

W Young

Keyword(s):

Cerebral Cortex ◽

Evoked Potentials ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Somatosensory Evoked Potentials ◽

Artery Occlusion ◽

Rat Cerebral Cortex ◽

Before And After ◽

Cerebral Artery Occlusion

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Editorial. Clipping versus coiling for the treatment of middle cerebral artery aneurysms: which modality should be considered first?

Journal of Neurosurgery ◽

10.3171/2019.5.jns191280 ◽

2020 ◽

Vol 133 (4) ◽

pp. 1120-1123

Author(s):

Tyler Scullen ◽

Mansour Mathkour ◽

John D. Nerva ◽

Aaron S. Dumont ◽

Peter S. Amenta

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Middle Cerebral Artery Aneurysms

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Effects of thrombolysis within 6 hours on acute cerebral infarction in an improved rat embolic middle cerebral artery occlusion model for ischaemic stroke

Journal of Cellular and Molecular Medicine ◽

10.1111/jcmm.14120 ◽

2019 ◽

Vol 23 (4) ◽

pp. 2468-2474 ◽

Cited By ~ 3

Author(s):

Zhihua Si ◽

Jinzhi Liu ◽

Ke Hu ◽

Yan Lin ◽

Jie Liu ◽

...

Keyword(s):

Cerebral Infarction ◽

Ischaemic Stroke ◽

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Artery Occlusion ◽

Acute Cerebral Infarction ◽

Occlusion Model ◽

Cerebral Artery Occlusion

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Study of Short Latency Somatosensory and Brain Stem Auditory Evoked Potentials Patients with Acute Ischemic Stroke Involving Middle Cerebral Artery Territory

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1727558 ◽

2021 ◽

Author(s):

Abhishek Miryala ◽

Mahendra Javali ◽

Anish Mehta ◽

Pradeep R. ◽

Purushottam Acharya ◽

...

Keyword(s):

Ischemic Stroke ◽

Evoked Potentials ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Brain Stem ◽

Functional Outcome ◽

Cerebral Artery ◽

Negative Correlation ◽

Auditory Evoked Potentials ◽

Positive Correlation

Abstract Background The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials. Objective The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months. Methods MCA territory involved acute ischemic stroke patients (n = 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded. Results P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index (p < 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index (p < 0.0001). Conclusion SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.

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