The Diagnostic Accuracy of Evoked Potential Monitoring Techniques during Intracranial Aneurysm Surgery for Predicting Postoperative Ischaemic Damage: A Systematic Review and Meta-analysis.

The Diagnostic Accuracy of Evoked Potential Monitoring Techniques during Intracranial Aneurysm Surgery for Predicting Postoperative Ischaemic Damage: A Systematic Review and Meta-analysis.

World Neurosurg. 2017 Apr 19;:

Authors: Thomas B, Guo D

Abstract
OBJECTIVE: To investigate the diagnostic accuracy of various evoked potential monitoring techniques in predicting postoperative neurological deficit in intracranial aneurysm surgery.
METHODS: A literature search of the MEDLINE, Embase and Cochrane databases was conducted for English language papers published between 31 March 1983 and 31 March 2016. Original studies that reported the use of evoked potential monitoring during intracranial aneurysm surgery in predicting postoperative neurological damage were selected, and their relevant reference lists were hand searched. Test performance characteristics were summarised using hierarchical summary receiver operating characteristic (ROC) curves and bivariable random-effects models.
RESULTS: Fourteen qualifying studies (1597 patients; 1689 aneurysms) from six countries were identified. Eight studies investigated the use of the SSEP monitoring technique, five investigated TcMEP and another five investigated DMEP. Bivariable pooled sensitivity and specificity were 48% (95% CI: 30.7, 65.0) and 92% (88, 94.4), respectively, for SSEP; 73% (21.0, 96.7) and 94% (87.1-97.5) for TcMEP; and 97% (74.43, 99.99) and 89% (84.0, 94.5) for DMEP. ROC curve analysis showed that TcMEP had the highest accuracy (area under ROC curve 90, 95% CI, 0.93-0.97), followed by DMEP (0.91, 0.89-0.94) and SSEP (0.88, 0.85-0.91).
CONCLUSION: TcMEP and DMEP have higher diagnostic accuracy than SSEP in predicting postoperative neurological deficit. The type of anaesthetic agent, the use of neuromuscular blocking drugs, and the choice of diagnostic criteria for significant change in cerebral blood flow during aneurysm surgery affects the diagnostic accuracy of evoked potential techniques in predicting postoperative neurological deficit.

PMID: 28433839 [PubMed - as supplied by publisher]

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