Hemorrhagic complications of intraoperative neurophysiologic monitoring needle electrodes

Publication date: Available online 21 April 2017
Source:Interdisciplinary Neurosurgery
Author(s): William J. Ares, Nitin Agarwal, Jeffrey Balzer, Brian T. Jankowitz
BackgroundIntraoperative neurophysiologic monitoring is a commonly used adjunct during many neurointerventional procedures.ObjectiveHere we describe the rare occurrence of a hemorrhagic complication secondary to a subdermal needle electrode.MethodsA 67year old male with a left-sided fusiform vertebrobasilar aneurysm was scheduled to undergo placement of a pipeline embolization device. The patient had been administered aspirin 325mg and Plavix 75mg daily for greater than one week preoperatively. After successfully undergoing endotracheal intubation, 7mm length and 0.4mm diameter subdermal needle electrode intraoperative monitoring leads were placed in the scalp, mastoid and bilateral Erb's points Following successful completion of the procedure, but prior to extubation and closure of the femoral arterial site, the patient was noted to have a significant amount of swelling in the left neck and supraclavicular region in the immediate vicinity of the left Erb's point subdermal needle electrode. Review of the last angiographic run in the region noted active extravasation from a muscular branch of the suprascapular artery immediately subjacent to the aforementioned subdermal electrode. The literature has been reviewed and recommendations for management and surveillance are made.ResultsThis case underscores the importance of monitoring and risk minimization in regards to hemorrhagic complications, especially in patients who are anticoagulated and receiving dual antiplatelet therapy, during neurointerventional procedures.ConclusionHemorrhagic complications associated with subdermal needle electrodes, though rare, can have significant consequences in patients.



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