Somatosensory evoked potential monitoring during endoscopic endonasal approach to skull base surgery: analysis of observed changes.

Abstract:

BACKGROUND:Intraoperative neurophysiological monitoring, including upper- and lower-extremity somatosensory evoked potentials (SSEPs), has been used to identify and prevent injury to neurovascular structures during conventional skull base surgery. The expanded endonasal approach (EEA) is a novel minimally invasive approach to skull base surgery. However, it carries the risk of injury to neurovascular structures, including the internal carotid artery, anterior cerebral artery, and cranial nerves. OBJECTIVE:To evaluate the value of SSEP monitoring to predict and/or prevent neurovascular deficits during EEA to skull base surgery. METHODS:We retrospectively identified 999 consecutive patients who had intraoperative neurophysiological monitoring during EEA skull base surgery at our institution. A total of 976 patients had SSEP monitoring and a documented postoperative neurological examination. RESULTS:The incidence of changes in SSEP during the procedure was 20 of 976 (2%). The incidence of new postoperative neurological deficits was 5 of 976 (0.5%). The positive and negative predictive values of SSEPs during EEA to predict neurovascular deficits were 80.00% and 99.79%, respectively. CONCLUSION:Intraoperative SSEP monitoring was able to identify impending risk to neurovascular structures to prevent permanent postoperative neurological deficits. We advocate a comprehensive approach to neurophysiological monitoring during EEAs, including SSEPs, spontaneous and triggered electromyography of the cranial nerves III through XII, brainstem auditory evoked potentials, and electroencephalogram, depending on the surgical approach and location of the neural structures at risk.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Thirumala PD,Kassasm AB,Habeych M,Wichman K,Chang YF,Gardner P,Prevedello D,Snyderman C,Carrau R,Crammond DJ,Balzer J

doi

10.1227/NEU.0b013e31821606e4

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

ons64-76; discussion ons76

issue

1 Suppl Operative

eissn

0148-396X

issn

1524-4040

journal_volume

69

pub_type

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