Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery: Technique Application for 30 Consecutive Patients

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 916-924 ◽  
Author(s):  
Alfredo Quiñones-Hinojosa ◽  
Mirza Alam ◽  
Russ Lyon ◽  
Charles D. Yingling ◽  
Michael T. Lawton
Keyword(s):  
Basilar Artery ◽  
Evoked Potential ◽  
Superficial Temporal Artery ◽  
Motor Evoked Potential ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Neurophysiological Monitoring ◽  
Aneurysm Surgery ◽  
Basilar Artery Aneurysm ◽  
Temporary Occlusion

Abstract OBJECTIVE Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring. METHODS Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients. RESULTS All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33%), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P < 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken. CONCLUSION TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.

Adenosine-induced transient asystole for management of a basilar artery aneurysm

1999 ◽  
Vol 91 (4) ◽  
pp. 687-690 ◽  
Author(s):  
Michael W. Groff ◽  
David C. Adams ◽  
Ronald A. Kahn ◽  
Uday M. Kumbar ◽  
Bo-Yi Yang ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Circulatory Arrest ◽  
Artery Aneurysm ◽  
Deep Hypothermic Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Basilar Artery Aneurysm ◽  
Profound Hypotension ◽  
Definition Of ◽  
Temporary Clipping

✓ Advances in anesthetic and surgical management, such as induced deep hypothermic circulatory arrest and application of temporary clips, have improved outcome for patients with basilar artery aneurysms. Nonetheless, these techniques are associated with significant risks. The authors report a case in which three transient periods of cardiac asystole were induced during basilar artery aneurysm surgery. Adenosine-induced asystole facilitated the safe clipping of the aneurysm by producing consistent periods of profound hypotension and collapse of the aneurysm without the need for temporary clipping. This technique provided unencumbered identification of perforating arteries, precise definition of the local anatomy, and an ideal environment for the safe placement of the aneurysm clip.

Comprehensive analysis of perforator territory infarction on postoperative diffusion-weighted imaging in patients with surgically treated unruptured intracranial saccular aneurysms

2020 ◽  
Vol 132 (4) ◽  
pp. 1088-1095 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Hiroyasu Kamiyama ◽  
Takanori Miyazaki ◽  
Yu Kinoshita ◽  
Nakao Ota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Basilar Artery ◽  
Diffusion Weighted Imaging ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Aneurysm Surgery ◽  
Poor Outcome ◽  
Diffusion Weighted ◽  
Direct Injury ◽  
Saccular Aneurysms

OBJECTIVEPerforator territory infarction (PTI) is still a major problem needing to be solved to achieve good outcomes in aneurysm surgery. However, details and risk factors of PTI diagnosed on postoperative MRI remain unknown. The authors aimed to investigate the details of PTI on postoperative diffusion-weighted imaging (DWI) in patients with surgically treated unruptured intracranial saccular aneurysms (UISAs).METHODSThe data of 848 patients with 1047 UISAs were retrospectively evaluated. PTI was diagnosed on DWI, which was performed the day after aneurysm surgery. Clinical and radiological characteristics were compared between UISAs with and without PTI. Poor outcome was defined as an increase in 1 or more modified Rankin Scale scores at 12 months after aneurysm surgery.RESULTSPostoperative DWI was performed in all cases, and it revealed PTI in 56 UISA cases (5.3%). Forty-three PTIs occurred without direct injury and occlusion of perforators (43 of 56, 77%). Poor outcome was more frequently observed in the PTI group (17 of 56, 30%) than the non-PTI group (57 of 1047, 5.4%) (p < 0.0001). Thalamotuberal arteries (p < 0.01), lateral striate arteries (p < 0.01), Heubner’s artery (p < 0.01), anterior median commissural artery (p < 0.05), terminal internal carotid artery perforators (p < 0 0.01), and basilar artery perforator (p < 0 0.01) infarctions were related to poor outcome by adjusted residual analysis. On multivariate analysis, statin use (OR 10, 95% CI, 3.3–31; p < 0.0001), specific aneurysm locations (posterior communicating artery [OR 4.1, 95% CI 2.1–8.1; p < 0.0001] and basilar artery [OR 3.1, 95% CI 1.1–8.9; p = 0.031]), larger aneurysm size (OR 1.1, 95% CI 1.1–1.2; p = 0.043), and permanent decrease of motor evoked potential (OR 38, 95% CI 3.1–468; p = 0.0045) were related to PTI.CONCLUSIONSDespite efforts to avoid PTI, it occurred even without direct injury, occlusion of perforators, or evoked potential abnormality. Therefore, surgical treatment of UISAs, especially with the aforementioned risk factors of PTI, should be more carefully considered. The evaluation of PTI in the territory of the above-mentioned perforators could be useful in helping predict the clinical course in patients after aneurysm surgery.

Twenty-Year Follow-up of Flow Reversal and Revascularization for a Giant Serpentine Basilar Artery Aneurysm

2014 ◽  
Vol 10 (3) ◽  
pp. E493-E497 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Joseph M. Zabramski ◽  
Peter Nakaji ◽  
Robert F. Spetzler
Keyword(s):  
Basilar Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Flow Reversal ◽  
Superior Cerebellar Artery ◽  
Brainstem Compression ◽  
Posterior Circulation Aneurysms

Abstract BACKGROUND AND IMPORTANCE: Current microsurgical and endovascular therapies have offered little advancement for the treatment of complex vertebrobasilar aneurysms. The outcome of patients with these rare lesions has remained poor, despite sometimes heroic measures. CLINICAL PRESENTATION: The authors report a case of a 65-year-old man who 20 years earlier had presented with symptoms suggestive of brainstem compression. Imaging at the time revealed a giant, serpentine aneurysm of the basilar artery. The patient was treated with superficial temporal artery to superior cerebellar artery bypass and decompression of the aneurysm contents. Twenty years after this treatment, the patient remains functionally intact with few sequelae from his treatment or the pathology. Follow-up imaging reveals thrombosis of the aneurysm without ischemic damage to the brainstem. CONCLUSION: This case demonstrates that good functional outcomes are possible for select complex posterior circulation aneurysms by using flow reversal and revascularization; however, at this time, we are unable to predict for which patients this strategy will be successful.

The First Description of a Basilar Artery Aneurysm Rupture in 1836

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Andreas Demetriades ◽  
Takashi Horiguchi ◽  
James Goodrich ◽  
Takeshi Kawase
Keyword(s):  
Basilar Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Basilar Artery Aneurysm

Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”

2009 ◽  
Vol 3 (6) ◽  
pp. 496-500 ◽  
Author(s):  
R. Webster Crowley ◽  
Avery J. Evans ◽  
Neal F. Kassell ◽  
Mary E. Jensen ◽  
Aaron S. Dumont
Keyword(s):  
Basilar Artery ◽  
Pediatric Patients ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
High Morbidity ◽  
Endovascular Techniques ◽  
Basilar Artery Aneurysm ◽  
Open Surgical Treatment ◽  
Cumulative Risks ◽  
Frequent Presence

Fusiform aneurysms of the basilar artery present difficult challenges for the treating physician. On one hand, these aneurysms are difficult and dangerous to treat. On the other, the relatively high rupture rate, risk of thromboemboli, and the frequent presence of mass effect on the brainstem often demand treatment rather than observation. While conservative treatment may be reasonable in an elderly patient, the relative resiliency and the larger lifetime cumulative risks of pediatric patients are compelling arguments for treatment. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment, albeit with risks of their own. The authors present the case of a fusiform aneurysm arising from a severely tortuous basilar artery in a 22-month-old boy. The aneurysm was successfully treated using flow diversion by placing multiple intracranial stents without coil embolization. This allowed for thrombosis of the aneurysm and resolution of the mass effect on the brainstem without compromising blood flow to the brainstem.

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