Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Liu, A. Y. Articles by Marks, M. P. Search for Related Content PubMed PubMed Citation Articles by Liu, A. Y. Articles by Marks, M. P.

American Journal of Neuroradiology 24:1520-1527, September 2003
© 2003 American Society of Neuroradiology

INTERVENTIONAL

Neurophysiological Monitoring in the Endovascular Therapy of Aneurysms

Amon Y. Liu^a, Jaime R. Lopez^a, Huy M. Do^a, Gary K. Steinberg^a, Kevin Cockroft^b and Michael P. Marks^a

^a Stanford University Medical Center, Stanford, CA
^b Penn State Milton S. Hershey Medical Center, Hershey, PA

Address reprint requests to Michael P. Marks, MD, Stanford University School of Medicine, Department of Radiology, 300 Pasteur Drive, Room S-047, MC: 5105, Stanford, CA 94305

BACKGROUND PURPOSE: Endovascular aneurysm therapy has associated risks of ischemic complications. We undertook this study to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms.

METHODS: Thirty-five patients underwent NPM during endovascular treatment of cerebral aneurysms. The patients underwent a total of 50 endovascular procedures, including balloon test occlusion (19 patients), GDC embolization (22 patients), and permanent vessel occlusion (nine patients). NPM included electroencephalography, somatosensory evoked potentials, and/or brain stem auditory evoked potentials, depending on the location of the aneurysm.

RESULTS: NPM changes were seen in nine (26%) of 35 patients and altered the management in five (14%) of 35 patients. In three of the five cases, NPM changes were observed without corresponding neurologic physical examination changes after balloon test occlusion (performed while the patients were under general anesthesia in two cases). In the two other cases in which NPM changes altered management, ischemia was detected at the time of intra-aneurysmal therapy while the patients were under general anesthesia. Overall, 18 of 35 patients underwent a total of 19 balloon test occlusion procedures. Of the 17 remaining patients, 13 underwent aneurysm coiling, two were not treated because of inability to safely place coils, and two were treated for distal aneurysms. Two patients developed transient neurologic deficits without concurrent NPM changes, representing false-negative NPM test results.

CONCLUSION: NPM is a valuable adjunct to endovascular treatment of cerebral aneurysms. Our study suggests that these monitoring techniques may reduce ischemic complications and can be used to help guide therapeutic decisions.

This article has been cited by other articles:

				H.-J. Priebe Aneurysmal subarachnoid haemorrhage and the anaesthetist Br. J. Anaesth., July 1, 2007; 99(1): 102 - 118. [Abstract] [Full Text] [PDF]

				J. L. Brisman, J. K. Song, and D. W. Newell Cerebral aneurysms. N. Engl. J. Med., August 31, 2006; 355(9): 928 - 939. [Full Text] [PDF]