Intraoperative neuromonitoring during microsurgical clipping for unruptured anterior choroidal artery aneurysm

Hyoung Soo Byoun, Chang Wan Oh, O-Ki Kwon, Si Un Lee, Seung Pil Ban, Sung Hoon Kim, Tackeun Kim, Jae Seung Bang, Sung Un Kim, Jongsuk Choi, Kyung Seok Park

Research output: Contribution to journalArticle

Abstract

Objective: To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm. Patients and methods: From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated. Results: Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972–1.000), PPVs; 100% (95% CI = 0.055–1.000), and NPVs; 93% (95% CI = 0.945–0.973) with low sensitivity; 11.1% (95% CI = 0.006–0.111) were calculated. Conclusions: IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.

Original languageEnglish
Article number105503
Pages (from-to)105503
JournalClinical Neurology and Neurosurgery
Volume186
DOIs
StatePublished - 1 Nov 2019

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Aneurysm
Arteries
Motor Evoked Potentials
Confidence Intervals
Somatosensory Evoked Potentials
Safety
Sensitivity and Specificity
Incidence

Keywords

  • Aneurysm
  • Anterior choroidal artery
  • Intraoperative neuromonitoring
  • Ischemic complication
  • Microsurgical clipping

Cite this

@article{77f4a22bbc08400392f92b6902630fc8,
title = "Intraoperative neuromonitoring during microsurgical clipping for unruptured anterior choroidal artery aneurysm",
abstract = "Objective: To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm. Patients and methods: From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated. Results: Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08{\%}). Among them, 3 were symptomatic (2.6{\%}). The false-negative rate of IONM for ischemic complications was 6.08{\%} (7 patients). High specificity; 100{\%} (95{\%} confidence interval [95{\%} CI] = 0.972–1.000), PPVs; 100{\%} (95{\%} CI = 0.055–1.000), and NPVs; 93{\%} (95{\%} CI = 0.945–0.973) with low sensitivity; 11.1{\%} (95{\%} CI = 0.006–0.111) were calculated. Conclusions: IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.",
keywords = "Aneurysm, Anterior choroidal artery, Intraoperative neuromonitoring, Ischemic complication, Microsurgical clipping",
author = "Byoun, {Hyoung Soo} and Oh, {Chang Wan} and O-Ki Kwon and Lee, {Si Un} and Ban, {Seung Pil} and Kim, {Sung Hoon} and Tackeun Kim and Bang, {Jae Seung} and Kim, {Sung Un} and Jongsuk Choi and Park, {Kyung Seok}",
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language = "English",
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pages = "105503",
journal = "Clinical Neurology and Neurosurgery",
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Intraoperative neuromonitoring during microsurgical clipping for unruptured anterior choroidal artery aneurysm. / Byoun, Hyoung Soo; Oh, Chang Wan; Kwon, O-Ki; Lee, Si Un; Ban, Seung Pil; Kim, Sung Hoon; Kim, Tackeun; Bang, Jae Seung; Kim, Sung Un; Choi, Jongsuk; Park, Kyung Seok.

In: Clinical Neurology and Neurosurgery, Vol. 186, 105503, 01.11.2019, p. 105503.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intraoperative neuromonitoring during microsurgical clipping for unruptured anterior choroidal artery aneurysm

AU - Byoun, Hyoung Soo

AU - Oh, Chang Wan

AU - Kwon, O-Ki

AU - Lee, Si Un

AU - Ban, Seung Pil

AU - Kim, Sung Hoon

AU - Kim, Tackeun

AU - Bang, Jae Seung

AU - Kim, Sung Un

AU - Choi, Jongsuk

AU - Park, Kyung Seok

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objective: To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm. Patients and methods: From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated. Results: Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972–1.000), PPVs; 100% (95% CI = 0.055–1.000), and NPVs; 93% (95% CI = 0.945–0.973) with low sensitivity; 11.1% (95% CI = 0.006–0.111) were calculated. Conclusions: IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.

AB - Objective: To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm. Patients and methods: From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated. Results: Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972–1.000), PPVs; 100% (95% CI = 0.055–1.000), and NPVs; 93% (95% CI = 0.945–0.973) with low sensitivity; 11.1% (95% CI = 0.006–0.111) were calculated. Conclusions: IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.

KW - Aneurysm

KW - Anterior choroidal artery

KW - Intraoperative neuromonitoring

KW - Ischemic complication

KW - Microsurgical clipping

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U2 - 10.1016/j.clineuro.2019.105503

DO - 10.1016/j.clineuro.2019.105503

M3 - Article

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JO - Clinical Neurology and Neurosurgery

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ER -