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a Department of
Neurology, b Department of
Neurosurgery, c The Stanford Stroke Center, Stanford Medical
Center, Stanford, CA 94305, USA
Correspondence to: Dr Jaime R Lopez, Department of Neurology, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA. Telephone 001 650 723 1975; fax 001 650 725 7459; email ma.jrl{at}forsythe.stanford.edu
Received 30 December
1998 and in revised form 15 June 1998;
Accepted 13 July
1998
OBJECTIVES
Somatosensory
evoked potentials (SSEPs) and brainstem auditory evoked potentials
(BAEPs) have been increasingly utilised during surgery for intracranial
aneurysms to identify cerebral ischaemia. Between July 1994 and April
1996, we surgically treated 70 aneurysms in 49 consecutive patients (58 operations) with the aid of intraoperative evoked potential monitoring.
This study sought to evaluate the usefulness of SSEP and BAEP
monitoring during intracranial aneurysm surgery.
METHODSMean patient
age was 51.9 (range 18-79) years. The sizes of the aneurysms were 3-4
mm (15), 5-9 mm (26), 10-14 mm (11), 15-19 mm (seven), 20-24 mm
(six), and >25 mm (five). SSEPs were monitored in 58 procedures
(100%) and BAEPs in 15 (26%). The neurological status of the patients
was evaluated before and after surgery.
RESULTSThirteen of
the 58 procedures (22%) monitored with SSEPs had SSEP changes (12 transient, one persistent); 45 (78%) had no SSEP changes. Three of 15 patients (20%) monitored with BAEPs had changes (two transient, one
persistent); 12 (80%) had no BAEP changes. Of the 14 patients with
transient SSEP or BAEP changes, these changes resolved with adjustment
or removal of aneurysm clips (nine), elevating MAP (four), or retractor
adjustment (one). Mean time from precipitating event to
electrophysiological change was 8.9 minutes (range 3-32), and the mean
time for recovery of potentials in patients with transient changes was
20.2 minutes (range 3-60). Clinical outcome was excellent in 39 patients, good in five, and poor in three (two patients died), and was
largely related to pretreatment grade.
CONCLUSIONSSSEPs and
BAEPs are useful in preventing clinical neurological injury during
surgery for intracranial aneurysms and in predicting which patients
will have unfavourable outcomes.
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