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Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view
INTRODUCTION: Intraoperative neuromonitoring (IOM) of motor/somatosensory evoked potentials is a well-established approach for reducing ischemic complications after aneurysm clipping. RESEARCH QUESTION: To determine the predictive validity of IOM for postoperative functional outcome and its perceive...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293320/ https://www.ncbi.nlm.nih.gov/pubmed/37383469 http://dx.doi.org/10.1016/j.bas.2023.101759 |
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author | Baumgart, Lea Wagner, Arthur Dorier, Anne-Sophie Droese, Doris Aftahy, Amir K. Wostrack, Maria Ille, Sebastian Meyer, Bernhard Krieg, Sandro M. |
author_facet | Baumgart, Lea Wagner, Arthur Dorier, Anne-Sophie Droese, Doris Aftahy, Amir K. Wostrack, Maria Ille, Sebastian Meyer, Bernhard Krieg, Sandro M. |
author_sort | Baumgart, Lea |
collection | PubMed |
description | INTRODUCTION: Intraoperative neuromonitoring (IOM) of motor/somatosensory evoked potentials is a well-established approach for reducing ischemic complications after aneurysm clipping. RESEARCH QUESTION: To determine the predictive validity of IOM for postoperative functional outcome and its perceived added value for intraoperative real-time feedback of functional impairment in the surgical treatment of unruptured intracranial aneurysms (UIAs). MATERIAL AND METHODS: Prospective study of patients scheduled for elective clipping of UIAs between 02/2019–02/2021. Transcranial motor evoked potentials (tcMEP) were used in all cases, a significant decline was defined as loss of ≥50% in amplitude or 50% latency increase. Clinical data were correlated to postoperative deficits. A surgeon's questionnaire was conceived. RESULTS: 47 patients were included, median age 57 years (range 26–76). IOM was successful in all cases. In 87.2%, IOM was stable throughout surgery, although 1 patient (2.4%) demonstrated a permanent postoperative neurological deficit. All patients with an intraoperatively reversible tcMEP-decline (12.7%) showed no surgery-related deficit, regardless of the decline duration (range 0.5–40.0 min; mean: 13.8). Temporary clipping (TC) was performed in 12 cases (25.5%), with a decline in amplitude in 4 patients. After clip-removal, all amplitudes returned to baseline. IOM provided the surgeon with a higher sense of security in 63.8%. DISCUSSION AND CONCLUSION: IOM remains invaluable during elective microsurgical clipping, particularly during TC of MCA and AcomA-aneurysms. It alerts the surgeon of impending ischemic injury and offers a way of maximizing the time frame for TC. IOM has highly increased surgeons’ subjective feeling of security during the procedure. |
format | Online Article Text |
id | pubmed-10293320 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-102933202023-06-28 Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view Baumgart, Lea Wagner, Arthur Dorier, Anne-Sophie Droese, Doris Aftahy, Amir K. Wostrack, Maria Ille, Sebastian Meyer, Bernhard Krieg, Sandro M. Brain Spine Article INTRODUCTION: Intraoperative neuromonitoring (IOM) of motor/somatosensory evoked potentials is a well-established approach for reducing ischemic complications after aneurysm clipping. RESEARCH QUESTION: To determine the predictive validity of IOM for postoperative functional outcome and its perceived added value for intraoperative real-time feedback of functional impairment in the surgical treatment of unruptured intracranial aneurysms (UIAs). MATERIAL AND METHODS: Prospective study of patients scheduled for elective clipping of UIAs between 02/2019–02/2021. Transcranial motor evoked potentials (tcMEP) were used in all cases, a significant decline was defined as loss of ≥50% in amplitude or 50% latency increase. Clinical data were correlated to postoperative deficits. A surgeon's questionnaire was conceived. RESULTS: 47 patients were included, median age 57 years (range 26–76). IOM was successful in all cases. In 87.2%, IOM was stable throughout surgery, although 1 patient (2.4%) demonstrated a permanent postoperative neurological deficit. All patients with an intraoperatively reversible tcMEP-decline (12.7%) showed no surgery-related deficit, regardless of the decline duration (range 0.5–40.0 min; mean: 13.8). Temporary clipping (TC) was performed in 12 cases (25.5%), with a decline in amplitude in 4 patients. After clip-removal, all amplitudes returned to baseline. IOM provided the surgeon with a higher sense of security in 63.8%. DISCUSSION AND CONCLUSION: IOM remains invaluable during elective microsurgical clipping, particularly during TC of MCA and AcomA-aneurysms. It alerts the surgeon of impending ischemic injury and offers a way of maximizing the time frame for TC. IOM has highly increased surgeons’ subjective feeling of security during the procedure. Elsevier 2023-05-20 /pmc/articles/PMC10293320/ /pubmed/37383469 http://dx.doi.org/10.1016/j.bas.2023.101759 Text en © 2023 The Authors. Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Baumgart, Lea Wagner, Arthur Dorier, Anne-Sophie Droese, Doris Aftahy, Amir K. Wostrack, Maria Ille, Sebastian Meyer, Bernhard Krieg, Sandro M. Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title | Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title_full | Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title_fullStr | Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title_full_unstemmed | Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title_short | Predictive value of IOM in clipping of unruptured intracranial aneurysms – A prospective study from the surgeon's point of view |
title_sort | predictive value of iom in clipping of unruptured intracranial aneurysms – a prospective study from the surgeon's point of view |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293320/ https://www.ncbi.nlm.nih.gov/pubmed/37383469 http://dx.doi.org/10.1016/j.bas.2023.101759 |
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