Somatosensory evoked potentials in cerebral aneurysm surgery. 1988

A Buchthal, and M Belopavlovic
Academisch Ziekenhuis Groningen, Instituut voor Anesthesiologie/NC en Intensive Care.

Somatosensory evoked potentials (SEP) were used intraoperatively 25 cerebral aneurysm cases during the temporary occlusion of the parent artery of the aneurysm under moderate hypothermia. This technique of vascular occlusion is very useful in facilitating the dissection of difficult aneurysms as well as in reducing the risk of intraoperative rupture. Middle cerebral artery (MCA) cases in Hunt & Hess's grade III, undergoing early surgery, who had shown a transient neurological deficit at the time of subarachnoid haemorrhage or where vasospasm was evident in intraoperatively were prominent among 6 cases where the median nerve SEP was lost within 13 minutes of temporary MCA occlusion at 28.6 degrees C to 31.1 degrees C. A transient neurological deficit was seen in one of these and a permanently increased deficit in the other. In contrast, the SEP was well maintained during occlusion times of upto 52 minutes in 8 cases in the absence of any of the above circumstances. The SEP was lost after 7 minutes in one of 5 cases of internal carotid artery occlusion; this was followed by a paresis of a few hours' duration. The posterior tibial nerve SEP was absent for one minute in one of 5 cases of bilateral A1 segment occlusion; none of these cases showed a postoperative deficit. It is concluded that 1. appropriate SEP monitoring can make a major contribution to patient safety in aneurysm surgery, 2. substantially longer cerebrovascular occlusion times are permissible during hypothermia than at normal temperatures and 3. the employment of additional cerebral protective measures should be considered in cases at high risk from ischaemic damage.

UI MeSH Term Description Entries
D007431 Intraoperative Complications Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. Peroperative Complications,Surgical Injuries,Complication, Intraoperative,Complication, Peroperative,Injuries, Surgical,Complications, Intraoperative,Complications, Peroperative,Injury, Surgical,Intraoperative Complication,Peroperative Complication,Surgical Injury
D008475 Median Nerve A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. Median Nerves,Nerve, Median,Nerves, Median
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D002532 Intracranial Aneurysm Abnormal outpouching in the wall of intracranial blood vessels. Most common are the saccular (berry) aneurysms located at branch points in CIRCLE OF WILLIS at the base of the brain. Vessel rupture results in SUBARACHNOID HEMORRHAGE or INTRACRANIAL HEMORRHAGES. Giant aneurysms (>2.5 cm in diameter) may compress adjacent structures, including the OCULOMOTOR NERVE. (From Adams et al., Principles of Neurology, 6th ed, p841) Aneurysm, Cerebral,Aneurysm, Intracranial,Basilar Artery Aneurysm,Berry Aneurysm,Brain Aneurysm,Cerebral Aneurysm,Giant Intracranial Aneurysm,Mycotic Aneurysm, Intracranial,Aneurysm, Anterior Cerebral Artery,Aneurysm, Anterior Communicating Artery,Aneurysm, Basilar Artery,Aneurysm, Middle Cerebral Artery,Aneurysm, Posterior Cerebral Artery,Aneurysm, Posterior Communicating Artery,Anterior Cerebral Artery Aneurysm,Anterior Communicating Artery Aneurysm,Middle Cerebral Artery Aneurysm,Posterior Cerebral Artery Aneurysm,Posterior Communicating Artery Aneurysm,Aneurysm, Berry,Aneurysm, Brain,Aneurysm, Giant Intracranial,Aneurysm, Intracranial Mycotic,Aneurysms, Basilar Artery,Aneurysms, Berry,Aneurysms, Brain,Aneurysms, Cerebral,Aneurysms, Giant Intracranial,Aneurysms, Intracranial,Aneurysms, Intracranial Mycotic,Artery Aneurysm, Basilar,Artery Aneurysms, Basilar,Basilar Artery Aneurysms,Berry Aneurysms,Brain Aneurysms,Cerebral Aneurysms,Giant Intracranial Aneurysms,Intracranial Aneurysm, Giant,Intracranial Aneurysms,Intracranial Aneurysms, Giant,Intracranial Mycotic Aneurysm,Intracranial Mycotic Aneurysms,Mycotic Aneurysms, Intracranial
D002545 Brain Ischemia Localized reduction of blood flow to brain tissue due to arterial obstruction or systemic hypoperfusion. This frequently occurs in conjunction with brain hypoxia (HYPOXIA, BRAIN). Prolonged ischemia is associated with BRAIN INFARCTION. Cerebral Ischemia,Ischemic Encephalopathy,Encephalopathy, Ischemic,Ischemia, Cerebral,Brain Ischemias,Cerebral Ischemias,Ischemia, Brain,Ischemias, Cerebral,Ischemic Encephalopathies
D004558 Electric Stimulation Use of electric potential or currents to elicit biological responses. Stimulation, Electric,Electrical Stimulation,Electric Stimulations,Electrical Stimulations,Stimulation, Electrical,Stimulations, Electric,Stimulations, Electrical
D005073 Evoked Potentials, Somatosensory The electric response evoked in the CEREBRAL CORTEX by stimulation along AFFERENT PATHWAYS from PERIPHERAL NERVES to CEREBRUM. Somatosensory Evoked Potentials,Evoked Potential, Somatosensory,Somatosensory Evoked Potential
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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