Article Figures & Data
Figures
- Fig 1.
Neurophysiological monitoring tracings from patient 5 after intraoperative rupture (A), showing a decrease in right upper extremity SSEP (left yellow box) and loss of bilateral lower extremity SSEP during aneurysm coiling (center and right yellow boxes). Tracing from a similar time point (B), showing a subtle decrease in amplitude of TcMEP involving the right upper extremity (small left yellow box) and a global loss of EEG (large right yellow box). After EVD insertion (C), recovery of SSEP (yellow boxes) can be seen. Concomitantly, there is a return of the normal TcMEP signal intensity and recovery of EEG (D) (yellow boxes).
- Fig 2.
Lateral view of left ICA angiogram (A) from patient 7 shows acute left M1 occlusion (angled arrow) and pericallosal region aneurysm (horizontal arrow). Neurophysiological monitoring tracings (B) show a decrease in right upper extremity SSEP before aneurysm coiling (yellow box). After IV tPA, there is improvement in angiographic opacification of most of the left MCA territory (C), but a posterior frontal M3 branch remains occluded (arrow). In addition, after administration of IV tPA (D), recovery of right upper extremity SSEP is seen (yellow box). After coiling of the aneurysm, thrombus formation was noted at the aneurysm neck (E). This was associated with new monitoring changes (F), specifically a decrease in the left upper extremity SSEP amplitude (left yellow box) and left lower extremity SSEP amplitude (right yellow box). Intra-arterial abciximab (ReoPro) was administered and follow-up angiographic images (G) showed resolution of the thrombus (arrow). Subsequently, SSEP tracings (H) showed minimal recovery of left upper extremity amplitude (left yellow box) and left lower extremity amplitude (right yellow box) by the end of the procedure.
Tables
- Table:
Summary of patients demonstrating changes in neurophysiological monitoring parameters
Patient Age (yrs) and Sex Diagnosis Procedure EEG SSEP TcMEP Immediate Outcome (GOS) Long-Term Outcome (GOS) 1 63 F Anterior communicating artery aneurysm Anterior communicating artery aneurysm coilinga + + 4 5 (25 months) 2 55 F Grade 5 SAH Right posterior inferior cerebellar artery aneurysm coiling + 2 1 (6 days) 3 56 F Grade 5 SAH Anterior communicating artery aneurysm coiling + 2 1 (6 days) 4 69 F Grade 1 SAH Right anterior choroidal and posterior communicating artery aneurysms + 4 5 (8 months) 5 34 F Grade 1 SAH Anterior communicating artery aneurysm coilinga + + + 4 5 (7 months) 6 62 F Grade 1 SAH Anterior communicating artery aneurysm coiling + 5 3 (28 months) 7 52 M Grade 1 SAH Left pericallosal artery aneurysm coiling + 4 4 (5 months) 8 67 F Grade 3 SAH Right middle cerebral artery aneurysm coiling + 3 5 (17 months) 9 53 M Grade 4 SAH Diagnostic angiogram + 4 5 (5 weeks) 10 71 F Left paraclinoid region aneurysm Precoiling stent placement + 5 5 (14 months) 11 57 F Grade 3 SAH Anterior communicating and right posterior communicating artery aneurysm coiling + 3 5 (4 months) -
Note:—“Grade” in SAH patients is Hunt-Hess grade. A change is indicated by a “+.”
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↵a Changes were simultaneous.
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