Somatosensory evoked potential changes in neuroendovascular procedures: incidence and association with clinical outcome in 873 patients.

Abstract:

BACKGROUND:Neurophysiological monitoring is routinely used during neurosurgical procedures. Use of neurophysiological monitoring has extended to neuroendovascular procedures, but evidence of its impact on clinical outcome in this arena is limited. OBJECTIVE:To report the incidence of significant intraoperative somatosensory evoked potential (SSEP) changes during neuroendovascular surgery and to correlate SSEP changes with clinical outcomes. METHODS:Patients who underwent neuroendovascular surgery at our institution between 2011 and 2013 were included in the analysis. Medical charts and imaging studies were reviewed retrospectively for sex, age, lesion type and size, clinical presentation, type of endovascular procedure, duration of SSEP change, reversibility of SSEP change, incidence of intraoperative complications and related mortalities, presence of new infarction within 72 hours of intervention, and discharge outcome. RESULTS:Of 873 consecutive patients, 52 (6%) had clinically significant intraoperative SSEP changes. Twenty-four patients (46%) had SSEP changes that were corrected, and 28 patients (54%) had changes that were not reversed before the end of surgery. Both decreased duration and reversal of SSEP changes were associated with a lower incidence of postoperative infarction and more favorable clinical outcome on discharge. The positive predictive value of an irreversible SSEP change for postoperative infarction in our study was 21%, and the negative predictive value was 83%. CONCLUSION:The approximate incidence of SSEP changes is 6% during neuroendovascular procedures. Rapid reversal of SSEP changes is associated with better outcomes. SSEP monitoring may be a valuable tool for preventing complications after neuroendovascular interventions.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Phillips JL,Chalouhi N,Jabbour P,Starke RM,Bovenzi CD,Rosenwasser RH,Wilent WB,Romo VM,Tjoumakaris SI

doi

10.1227/NEU.0000000000000510

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

560-7; discussion 566-7; quiz 567

issue

5

eissn

0148-396X

issn

1524-4040

journal_volume

75

pub_type

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