Somatosensory Evoked Potentials During Temporary Arterial Occlusion for Intracranial Aneurysm Surgery: Predictive Value for Perioperative Stroke.

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Somatosensory Evoked Potentials During Temporary Arterial Occlusion for Intracranial Aneurysm Surgery: Predictive Value for Perioperative Stroke.

World Neurosurg. 2017 May 16;:

Authors: Kashkoush AI, Jankowitz BT, Gardner P, Friedlander RM, Chang YF, Crammond DJ, Balzer JR, Thirumala PD

Abstract
BACKGROUND: Temporary arterial occlusion (TAO) is a valuable tool for minimizing intraoperative rupture risk during intracranial aneurysm microsurgery; however, it may also be associated with ischemic injury.
OBJECTIVE: This study aims to identify surgical and intraoperative neurophysiological monitoring (IONM) factors that predict perioperative stroke risk after TAO.
METHODS: We performed a retrospective chart review of 177 intracranial aneurysm surgeries at our institution, in which TAO was performed before the placement of a permanent clip under monitoring with somatosensory evoked potentials (SSEPs) and electroencephalography (EEG). Perioperative stroke was defined as a new-onset neurological deficit that developed within 24 hours postoperatively that was correlated with hypodensity on postoperative computed tomography.
RESULTS: Ten (6%) patients developed perioperative stroke in the vascular territory of TAO. SSEP changes were observed in 50% (5/10) of patients with perioperative stroke and in 14% (24/167) of patients without SSEP changes (p=0.003). The mean maximum single-episode TAO duration for patients that developed perioperative stroke was 12.6 minutes (95% confidence interval, 8.1-17.1) and that for patients without strokes was 8.0 (95% confidence interval, 7.3-8.7) minutes (p=0.026). In patients with SSEP changes, the risk of stroke was particularly elevated with unruptured aneurysms (p=0.013), relative to patients with ruptured aneurysms, respectively. Temporary clip location, number of occlusive episodes, onset and duration of IONM changes, and rupture status were not predictive of perioperative stroke.
CONCLUSIONS: SSEP changes and increased single-episode TAO durations are independently associated with increased perioperative stroke risk. SSEP changes are most predictive for perioperative stroke in unruptured cases.

PMID: 28526648 [PubMed - as supplied by publisher]

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