Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.

Download Full-text

Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa002 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1076-1082 ◽

Cited By ~ 2

Author(s):

Norihiko Shiiya ◽

Kazumasa Tsuda ◽

Ken Yamanaka ◽

Daisuke Takahashi ◽

Naoki Washiyama ◽

...

Keyword(s):

Evoked Potential ◽

Spinal Cord Injuries ◽

Motor Evoked Potentials ◽

False Positive Rate ◽

Large Diameter ◽

Motor Evoked Potential ◽

Monitoring Methods ◽

Evoked Potential Monitoring ◽

Transcranial Motor Evoked Potentials ◽

Potential Monitoring

Abstract OBJECTIVES Canine experiments have shown that transoesophageal motor-evoked potential monitoring is feasible, safe and stable, with a quicker response to ischaemia and a better prognostic value than transcranial motor-evoked potentials. We aimed to elucidate whether or not these findings were clinically reproducible. METHODS A bipolar oesophageal electrode mounted on a large-diameter silicon tube and a train of 5 biphasic wave stimuli were used for transoesophageal stimulation. Results of 18 patients (median age 74.5 years, 13 males) were analysed. RESULTS There were no mortalities, spinal cord injuries or complications related with transoesophageal stimulation. Transcranial motor-evoked potential could not be monitored up to the end of surgery in 3 patients for unknown reasons, 2 of whom from the beginning. Transoesophageal motor-evoked potential became non-evocable after manipulation of a transoesophageal echo probe in 2 patients. Strenuous movement of the upper limbs during transoesophageal stimulation was observed in 3 patients. In 14 patients who successfully completed both monitoring methods up to the end of surgery (11 thoraco-abdominal and 3 descending aortic repair), the final results were judged as false positives in 6 by transcranial stimulation and in 1 by transoesophageal stimulation. The stimulation intensity was significantly lower and the upper limb amplitude was significantly higher by transoesophageal stimulation, while the lower limb amplitude was comparable. CONCLUSIONS Transoesophageal motor-evoked potential monitoring is clinically feasible and safe with a low false positive rate. A better electrode design is required to avoid its migration by transoesophageal echo manipulation. Further studies may be warranted. Clinical registration number UMIN000022320.

Download Full-text

Automatic Recruitment of the Motor System by Undetected Graspable Objects: A Motor-evoked Potential Study

Journal of Cognitive Neuroscience ◽

10.1162/jocn_a_01165 ◽

2017 ◽

Vol 29 (11) ◽

pp. 1918-1931 ◽

Cited By ~ 5

Author(s):

Nicolas A. McNair ◽

Ashleigh D. Behrens ◽

Irina M. Harris

Keyword(s):

Evoked Potentials ◽

Visual Processing ◽

Motor System ◽

Primary Motor Cortex ◽

Direct Evidence ◽

Motor Evoked Potentials ◽

Motor Evoked Potential ◽

Motor Action ◽

Motor Pathway ◽

The Right

Previous behavioral and neuroimaging studies have suggested that the motor properties associated with graspable objects may be automatically accessed when people passively view these objects. We directly tested this by measuring the excitability of the motor pathway when participants viewed pictures of graspable objects that were presented during the attentional blink (AB), when items frequently go undetected. Participants had to identify two briefly presented objects separated by either a short or long SOA. Motor-evoked potentials were measured from the right hand in response to a single TMS pulse delivered over the left primary motor cortex 250 msec after the onset of the second target. Behavioral results showed poorer identification of objects at short SOA compared with long SOA, consistent with an AB, which did not differ between graspable and nongraspable objects. However, motor-evoked potentials measured during the AB were significantly higher for graspable objects than for nongraspable objects, irrespective of whether the object was successfully identified or undetected. This provides direct evidence that the motor system is automatically activated during visual processing of objects that afford a motor action.

Download Full-text

Feasibility of intraoperative motor evoked potential monitoring during tethered cord surgery in infants younger than 12 months

Child s Nervous System ◽

10.1007/s00381-021-05316-3 ◽

2021 ◽

Author(s):

Johannes Herta ◽

Erdem Yildiz ◽

Daniela Marhofer ◽

Thomas Czech ◽

Andrea Reinprecht ◽

...

Keyword(s):

Motor Evoked Potentials ◽

Motor Evoked Potential ◽

Tethered Cord ◽

Motor Deficit ◽

Motor Deficits ◽

Irreversible Loss ◽

Intravenous Anesthesia ◽

Evoked Potential Monitoring ◽

Transcranial Motor Evoked Potentials ◽

Clinical Records

Abstract Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age. Methods A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical records were reviewed. Anesthesia during surgery was maintained by total intravenous anesthesia (TIVA). Results MEPs were present in all patients for the upper extremities and in 21 out of 22 infants for the lower extremities. Mean baseline stimulation intensity was 101 ± 20 mA. If MEPs were present at the end of surgery, no new motor deficit occurred. In the only case of MEP loss, preoperative paresis was present, and high baseline intensity thresholds were needed. MEP monitoring did not lead to any complications. TIVA was maintained with an average propofol infusion rate of 123.5 ± 38.2 µg/kg/min and 0.46 ± 0.17 µg/kg/min for remifentanil. Conclusion In spinal cord release surgery, the use of intraoperative MEP monitoring is indicated regardless of the patient’s age. We could demonstrate the feasibility and safety of MEP monitoring in infants if an adequate anesthetic regimen is applied. More data is needed to verify whether an irreversible loss of robust MEPs leads to motor deficits in this young age group.

Download Full-text

Neuroprotection for Spine Surgery

10.1093/med/9780190280253.003.0020 ◽

2017 ◽

Author(s):

Jess W. Brallier ◽

Jonathan S. Gal

Keyword(s):

Evoked Potentials ◽

Spine Surgery ◽

Motor Evoked Potentials ◽

Neurologic Injury ◽

Arterial Blood ◽

Increased Risk ◽

Physiologic Parameter ◽

The Common ◽

Transcranial Motor Evoked Potentials

Perioperative neurologic injury related to spine surgery, albeit rare, can result in devastating functional loss. As the number of spine operations has increased, so has the need for strategies designed to avoid and protect against such injury. This chapter reviews the common etiologies of neurologic deficits secondary to spine surgery and the factors that place patients at increased risk for developing these complications. The use of intraoperative neuromonitoring, including somatosensory evoked potentials (SSEPs), electromyography (EMG), and transcranial motor evoked potentials (TcMEPs), to detect surgical trespass of neuronal elements is also reviewed. The authors also summarize the role of physiologic parameter optimization, including mean arterial blood pressure and body temperature, and pharmacologic interventions, should an injury occur. Current practice guidelines for preventing and managing perioperative neurologic injury are described.

Download Full-text

False Negative and Positive Motor Evoked Potentials in One Patient: Is Single Motor Evoked Potential Monitoring Reliable Method?

Spine ◽

10.1097/brs.0b013e3181d8fabb ◽

2010 ◽

Vol 35 (18) ◽

pp. E912-E916 ◽

Cited By ~ 21

Author(s):

Jae-Young Hong ◽

Seung-Woo Suh ◽

Hitesh N. Modi ◽

Chang-Yong Hur ◽

Hae-Ryong Song ◽

...

Keyword(s):

Evoked Potentials ◽

Reliable Method ◽

Evoked Potential ◽

Motor Evoked Potentials ◽

False Negative ◽

Motor Evoked Potential ◽

Single Motor ◽

Evoked Potential Monitoring ◽

Potential Monitoring

Download Full-text

Faculty Opinions recommendation of Transcranial Motor-Evoked Potentials Are More Readily Acquired Than Somatosensory-Evoked Potentials in Children Younger Than 6 Years.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725891191.793534699 ◽

2017 ◽

Author(s):

John Bebawy

Keyword(s):

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Motor Evoked Potentials ◽

Transcranial Motor Evoked Potentials

Download Full-text

Influence of hemorrhage and subsequent fluid resuscitation on transcranial motor-evoked potentials under desflurane anesthesia in a swine model

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-020-00644-2 ◽

2021 ◽

Author(s):

Tadayoshi Kurita ◽

Shingo Kawashima ◽

Mohamed Mathar Sahib Ibrahim Khaleelullah ◽

Yoshiki Nakajima

Keyword(s):

Evoked Potentials ◽

Fluid Resuscitation ◽

Motor Evoked Potentials ◽

Swine Model ◽

Transcranial Motor Evoked Potentials

Download Full-text

Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials

Brain Communications ◽

10.1093/braincomms/fcaa226 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Davide Giampiccolo ◽

Cristiano Parisi ◽

Pietro Meneghelli ◽

Vincenzo Tramontano ◽

Federica Basaldella ◽

...

Keyword(s):

Evoked Potentials ◽

Brain Tumour ◽

Evoked Potential ◽

Corticospinal Tract ◽

Motor Evoked Potentials ◽

Motor Evoked Potential ◽

Motor Deficit ◽

Motor Deficits ◽

Brain Tumour Surgery

Abstract Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel–lesion–symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

Download Full-text