gms | German Medical Science

Objective: Intraoperative monitoring requires timely diagnosis of the reduction of cerebral blood flow and remnant of the aneurysm to prevent postoperative neurological deficits by impelling intraoperative decision making. The objective of this study is to evaluate the efficacy of the combined application of evoked potentials (EPs), indocyanine green angiography (ICGA) and microvascular doppler ultrasonography (MDU) during microsurgical treatment for cerebral aneurysms, and futher review the advantages and limitations of these monitoring techniques in our practical applications.

Method: Data from 155 patients with 169 anterior circulation aneurysms undergoing clipping surgery were recorded. Electrophysiological monitoring was performed throughout the surgery. ICGA and MDU evaluated cerebral blood flow before and after clip positioning during aneurysm surgery. Analysis was done to correlate the intraoperative monitoring events with postoperative outcomes.

Results: In these series, only 2 consequential somatosensory evoked potential (SEP) fluctuations were recorded that was correlated with motor evoked potential (MEP) alterations. Significant MEP change occurred in 13 out of a total 155 patients. During surgery with MDU, it was found that 5 patients with unexpected occluded parent and branching arteries were contemplated by ICGA and in another 1 patient, there was a compromised blood flow of the branching arteries. ICGA flow analysis showed 4 patients with small inadequate patency of the perforating arteries confirmed by MDU in a patient. Among all patients 7 acquired postoperative permanent motor deficit, a temporary motor deficit was contemplated in 1 patient, and 2 patients suffered a severe deterioration in clinical condition. Electrophysiological monitoring predicted new neurological deficit in 8 patients, and MDU combined with ICGA confined neurological deficits in 5 patients.

Conclusions: In our study, we have show, the efficacious role of EPs, ICGA and MDU in the microsurgery of antorior circulation aneurysms. Our results contemplated an integrated monitoring of EPs, ICGA and MDU in patients with an anterior circulation cerebral aneurysm, which might provide the guidance for surgeons in making indispensable adjustments to curtail the prevalence of complications.