Intraoperative neuromonitoring as real-time diagnostic for cerebral ischemia in endovascular treatment of ruptured brain aneurysms.

Autor: Al-Qudah AM; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Thirumala PD; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA., Anetakis KM; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA., Crammond DJ; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA., Algarni SA; Department of Clinical Neurosciences, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; Neuroscience Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia., AlMajali M; Department of Neurology, University of Iowa College of Medicine, Iowa City, IA, USA., Shandal V; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA., Gross BA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA., Lang M; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA., Bhatt NR; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Al-Bayati AR; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Nogueira RG; Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Balzer JR; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: balzerjr@upmc.edu.
Jazyk: angličtina
Zdroj: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2024 May; Vol. 161, pp. 69-79. Date of Electronic Publication: 2024 Feb 27.
DOI: 10.1016/j.clinph.2024.02.024
Abstrakt: Objective: To evaluate the diagnostic accuracy of intraoperative neurophysiological monitoring (IONM) during endovascular treatment (EVT) of ruptured intracranial aneurysms (rIA).
Methods: IONM and clinical data from 323 patients who underwent EVT for rIA from 2014-2019 were retrospectively reviewed. Significant IONM changes and outcomes were evaluated based on visual review of data and clinical documentation.
Results: Of the 323 patients undergoing EVT, significant IONM changes were noted in 30 patients (9.29%) and 46 (14.24%) experienced postprocedural neurological deficits (PPND). 22 out of 30 (73.33%) patients who had significant IONM changes experienced PPND. Univariable analysis showed changes in somatosensory evoked potential (SSEP) and electroencephalogram (EEG) were associated with PPND (p-values: <0.001 and <0.001, retrospectively). Multivariable analysis showed that IONM changes were significantly associated with PPND (Odd ratio (OR) 20.18 (95%CI:7.40-55.03, p-value: <0.001)). Simultaneous changes in both IONM modalities had specificity of 98.9% (95% CI: 97.1%-99.7%). While sensitivity when either modality had a change was 47.8% (95% CI: 33.9%-62.0%) to predict PPND.
Conclusions: Significant IONM changes during EVT for rIA are associated with an increased risk of PPND.
Significance: IONM can be used confidently as a real time neurophysiological diagnostic guide for impending neurological deficits during EVT treatment of rIA.
(Copyright © 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: