Diagnostic Accuracy of Somatosensory Evoked Potential Monitoring in Evaluating Neurological Complications During Endovascular Aneurysm Treatment

William J. Ares, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ramesh M. Grandhi, Department of Neurological Surgery, University of Texas Health Center at San Antonio, San Antonio, Texas.
David M. Panczykowski, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Gregory M. Weiner, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Parthasarathy Thirumala, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Miguel E. Habeych, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Donald J. Crammond, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Michael B. Horowitz, Pennsylvania Brain and Spine Institute, Butler, Pennsylvania.
Brian T. Jankowitz, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ashutosh Jadhav, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Follow
Tudor G. Jovin, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Andrew F. Ducruet, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Follow
Jeffrey Balzer, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Document Type

Article

Abstract

BACKGROUND: Somatosensory evoked potential (SSEP) monitoring is used extensively for early detection and prevention of neurological complications in patients undergoing many different neurosurgical procedures. However, the predictive ability of SSEP monitoring during endovascular treatment of cerebral aneurysms is not well detailed. OBJECTIVE: To evaluate the performance of intraoperative SSEP in the prediction postprocedural neurological deficits (PPNDs) after coil embolization of intracranial aneurysms. METHODS: This population-based cohort study included patients ≥18 years of age undergoing intracranial aneurysm embolization with concurrent SSEP monitoring between January 2006 and August 2012. The ability of SSEP to predict PPNDs was analyzed by multiple regression analyses and assessed by the area under the receiver operating characteristic curve. RESULTS: In a population of 888 patients, SSEP changes occurred in 8.6% (n = 77). Twenty-eight patients (3.1%) suffered PPNDs. A 50% to 99% loss in SSEP waveform was associated with a 20-fold increase in risk of PPND; a total loss of SSEP waveform, regardless of permanence, was associated with a greater than 200-fold risk of PPND. SSEPs displayed very good predictive ability for PPND, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.92). CONCLUSION: This study supports the predictive ability of SSEPs for the detection of PPNDs. The magnitude and persistence of SSEP changes is clearly associated with the development of PPNDs. The utility of SSEP monitoring in detecting ischemia may provide an opportunity for neurointerventionalists to respond to changes intraoperatively to mitigate the potential for PPNDs.

Keywords

Aneurysm, Endovascular surgery, Neurophysiologic monitoring

Medical Subject Headings

Cohort Studies; Endovascular Procedures; Evoked Potentials, Somatosensory; Female; Humans; Intracranial Aneurysm (diagnosis, physiopathology, surgery); Intraoperative Neurophysiological Monitoring; Male; Middle Aged; Postoperative Complications (diagnosis); Prognosis; Risk Assessment

Publication Date

2-1-2018

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

14

Issue

2

First Page

151

Last Page

157

PubMed ID

28633394

Digital Object Identifier (DOI)

10.1093/ons/opx104

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