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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Predictive value of neurophysiological monitoring with motor and somatosensory evoked potentials during mechanical endovascular therapy for acute ischemic stroke

Meeting Abstract

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  • Ehab Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Silke Wunderlich - Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Kornelia Kreiser - Neuroradiologische Abteilung, Klinikum rechts der Isar, Technische Universität München
  • Bernhard Hemmer - Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Claus Zimmer - Neuroradiologische Abteilung, Klinikum rechts der Isar, Technische Universität München
  • Sandro Krieg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Thomas Obermueller - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Stephanie Grund - Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 182

doi: 10.3205/14dgnc576, urn:nbn:de:0183-14dgnc5760

Published: May 13, 2014

© 2014 Shiban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Mechanical endovascular therapy (MET) is a promising adjuvant or stand-alone therapy for acute ischemic stroke caused by occlusion of a large vessel. However, only selected patients will potentially benefit from reperfusion. Real time monitoring of recanalisation success with regard to functional outcome is not possible because these procedures are usually performed in general anaesthesia. Herein, we present a novel application for evoked potential for real time monitoring of reperfusion success with respect to functional outcome during MET for acute ischemic stroke.

Method: Prospective observational study from 03/12 until 04/2013 of patients presenting with acute ischemic stroke that are eligible for MET. Transcranial motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) were applied during MET. The monitoring data were reviewed independently and related to clinical and radiological outcomes during follow-up. MEPs and SSEPs were measured throughout the intervention. Neurological outcome was assessed by the modified Rankin Scale and National Institutes of Health Stroke Scale at 0, 7 and 90 days following intervention.

Results: 20 patients were examined. MEPs and SSEPs were successful in 19 (95%) and 13 (65%) cases, respectively. There were 9, 7 and 4 patients with occlusion of the middle cerebral artery, internal carotid artery and basilar artery, respectively. Successful reperfusion was achieved in 16 cases (TICI-Reperfusion-Grade 2b or 3). MEPs sensitivity and specificity were 90.9% and 87.5% respectively. SSEPs sensitivity and specificity were 71.4% and 83.3%, respectively.

Conclusions: MEPs and SSEPs are safe and feasible methods of real time monitoring of reperfusion success with respect to functional outcome during MET for acute ischemic stroke. MEPs have higher rates of sensitivity and specificity than SSEP and seem better suited in such a setting in which a rapid setup is crucial.

Note: Ehab Shiban and Silke Wunderlich contributed equally.