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Neurosurgery:
doi: 10.1227/NEU.0000000000000510
RESEARCH - HUMAN - CLINICAL STUDIES: PDF Only

Somatosensory Evoked Potential Changes in Neuroendovascular Procedures: Incidence and Association with Clinical Outcome in 873 Patients.

Phillips, Jessica L. H. B.A.; Chalouhi, Nohra M.D.; Jabbour, Pascal M.D.; Starke, Robert M. M.D.; Bovenzi, Cory D. B.S.; Rosenwasser, Robert H. M.D.; Wilent, W. Bryan Ph.D.; Romo, Victor M. M.D.; Tjoumakaris, Stavropoula I. M.D.

Published Ahead-of-Print
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Abstract

Background: Neurophysiological monitoring (NPM) is routinely employed during neurosurgical procedures. Use of NPM has extended to neuroendovascular procedures, but evidence of its impact on clinical outcome in this arena is limited.

Objective: To report on the incidence of significant intraoperative somatosensory evoked potential (SSEP) changes during neuroendovascular surgery and correlate SSEP changes with clinical outcomes.

Methods: Patients who underwent neuroendovascular surgery at our institution between 2011 and 2013 were included in the analysis. Medical charts and imaging studies were reviewed retrospectively for sex, age, lesion type and size, clinical presentation, type of endovascular procedure, duration of SSEP change, reversibility of SSEP change, incidence of intraoperative complications and related mortalities, presence of new infarction within 72 hours of intervention, and discharge outcome.

Results: Of 873 consecutive patients, 52 (6%) had clinically significant intraoperative SSEP changes. Twenty-four patients (46%) had SSEP changes that were corrected, while 28 patients (54%) had changes that were not reversed before the end of surgery. Decreased duration and reversal of SSEP changes were both associated with lower incidence of postoperative infarction and more favorable clinical outcome upon discharge. The positive predictive value (PPV) of an irreversible SSEP change for postoperative infarction in our study was 21% while the negative predictive value (NPV) was 83%.

Conclusion: The approximate incidence of SSEP changes is 6% during neuroendovascular procedures. Rapid reversal of SSEP changes is associated with better outcomes. SSEP monitoring may be a valuable tool for preventing complications following neuroendovascular interventions.

Copyright (C) by the Congress of Neurological Surgeons

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