Neurophysiological monitoring in the endovascular therapy of aneurysms

Amon Y. Liu, Jaime R. Lopez, Huy M. Do, Gary K. Steinberg, Kevin Cockroft, Michael P. Marks

Research output: Contribution to journalArticle

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Abstract

BACKGROUND PURPOSE: Endovascular aneurysm therapy has associated risks of ischemic complications. We undertook this study to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms. METHODS: Thirty-five patients underwent NPM during endovascular treatment of cerebral aneurysms. The patients underwent a total of 50 endovascular procedures, including balloon test occlusion (19 patients), GDC embolization (22 patients), and permanent vessel occlusion (nine patients). NPM included electroencephalography, somatosensory evoked potentials, and/or brain stem auditory evoked potentials, depending on the location of the aneurysm. RESULTS: NPM changes were seen in nine (26%) of 35 patients and altered the management in five (14%) of 35 patients. In three of the five cases, NPM changes were observed without corresponding neurologic physical examination changes after balloon test occlusion (performed while the patients were under general anesthesia in two cases). In the two other cases in which NPM changes altered management, ischemia was detected at the time of intra-aneurysmal therapy while the patients were under general anesthesia. Overall, 18 of 35 patients underwent a total of 19 balloon test occlusion procedures. Of the 17 remaining patients, 13 underwent aneurysm coiling, two were not treated because of inability to safely place coils, and two were treated for distal aneurysms. Two patients developed transient neurologic deficits without concurrent NPM changes, representing false-negative NPM test results. CONCLUSION: NPM is a valuable adjunct to endovascular treatment of cerebral aneurysms. Our study suggests that these monitoring techniques may reduce ischemic complications and can be used to help guide therapeutic decisions.

Original languageEnglish (US)
Pages (from-to)1520-1527
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume24
Issue number8
StatePublished - Sep 2003

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Neurophysiological Monitoring
Aneurysm
Balloon Occlusion
Intracranial Aneurysm
Therapeutics
General Anesthesia
Endovascular Procedures
Somatosensory Evoked Potentials
Brain Stem Auditory Evoked Potentials
Neurologic Examination
Neurologic Manifestations

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Liu, A. Y., Lopez, J. R., Do, H. M., Steinberg, G. K., Cockroft, K., & Marks, M. P. (2003). Neurophysiological monitoring in the endovascular therapy of aneurysms. American Journal of Neuroradiology, 24(8), 1520-1527.
Liu, Amon Y. ; Lopez, Jaime R. ; Do, Huy M. ; Steinberg, Gary K. ; Cockroft, Kevin ; Marks, Michael P. / Neurophysiological monitoring in the endovascular therapy of aneurysms. In: American Journal of Neuroradiology. 2003 ; Vol. 24, No. 8. pp. 1520-1527.
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Liu, AY, Lopez, JR, Do, HM, Steinberg, GK, Cockroft, K & Marks, MP 2003, 'Neurophysiological monitoring in the endovascular therapy of aneurysms', American Journal of Neuroradiology, vol. 24, no. 8, pp. 1520-1527.

Neurophysiological monitoring in the endovascular therapy of aneurysms. / Liu, Amon Y.; Lopez, Jaime R.; Do, Huy M.; Steinberg, Gary K.; Cockroft, Kevin; Marks, Michael P.

In: American Journal of Neuroradiology, Vol. 24, No. 8, 09.2003, p. 1520-1527.

Research output: Contribution to journalArticle

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AU - Liu, Amon Y.

AU - Lopez, Jaime R.

AU - Do, Huy M.

AU - Steinberg, Gary K.

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AU - Marks, Michael P.

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N2 - BACKGROUND PURPOSE: Endovascular aneurysm therapy has associated risks of ischemic complications. We undertook this study to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms. METHODS: Thirty-five patients underwent NPM during endovascular treatment of cerebral aneurysms. The patients underwent a total of 50 endovascular procedures, including balloon test occlusion (19 patients), GDC embolization (22 patients), and permanent vessel occlusion (nine patients). NPM included electroencephalography, somatosensory evoked potentials, and/or brain stem auditory evoked potentials, depending on the location of the aneurysm. RESULTS: NPM changes were seen in nine (26%) of 35 patients and altered the management in five (14%) of 35 patients. In three of the five cases, NPM changes were observed without corresponding neurologic physical examination changes after balloon test occlusion (performed while the patients were under general anesthesia in two cases). In the two other cases in which NPM changes altered management, ischemia was detected at the time of intra-aneurysmal therapy while the patients were under general anesthesia. Overall, 18 of 35 patients underwent a total of 19 balloon test occlusion procedures. Of the 17 remaining patients, 13 underwent aneurysm coiling, two were not treated because of inability to safely place coils, and two were treated for distal aneurysms. Two patients developed transient neurologic deficits without concurrent NPM changes, representing false-negative NPM test results. CONCLUSION: NPM is a valuable adjunct to endovascular treatment of cerebral aneurysms. Our study suggests that these monitoring techniques may reduce ischemic complications and can be used to help guide therapeutic decisions.

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Liu AY, Lopez JR, Do HM, Steinberg GK, Cockroft K, Marks MP. Neurophysiological monitoring in the endovascular therapy of aneurysms. American Journal of Neuroradiology. 2003 Sep;24(8):1520-1527.