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Journal of Clinical Monitoring and Computing

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01-10-2021 | Motor Evoked Potential | Original Research

Motor evoked potential monitoring can evaluate ischemic tolerance to carotid artery occlusion during surgery

Authors: Yoshiaki Takamura, Yasushi Motoyama, Tsunenori Takatani, Yasuhiro Takeshima, Ryosuke Matsuda, Kentaro Tamura, Shuichi Yamada, Fumihiko Nishimura, Ichiro Nakagawa, Young-Su Park, Hiroyuki Nakase

Published in: Journal of Clinical Monitoring and Computing | Issue 5/2021

Abstract

Balloon test occlusion (BTO) is a useful examination for evaluating ischemic tolerance to internal carotid artery (ICA) occlusion. The aim of this study was to investigate the relationships between intraoperative motor evoked potential (MEP) monitoring and the results of preoperative BTO. Between 2013 and 2017, 32 patients undergoing surgery under general anesthesia with intraoperative MEP monitoring, in whom preoperative BTO was performed, were identified. A receiver operator characteristic (ROC) analysis was performed to determine the appropriate cutoff value of MEP amplitude for BTO-positive. Furthermore, the accuracy of MEP monitoring for BTO-positive was compared with electroencephalogram (EEG) and somatosensory evoked potential (SEP) monitoring. Four of 32 (12.5%) patients were BTO-positive. The cutoff value of MEP amplitude for BTO-positive was a > 80% reduction from the baseline level, which showed sensitivity of 100% and specificity of 100%. Thus, the sensitivity and specificity for BTO-positive were significantly higher for MEP than for EEG (100% and 72.0%, p = 0.02) in 28 patients, but they were not significantly different compared with SEP (33.3% and 100%, p = 0.48) in 21 patients. MEP monitoring might be one of the alternatives for evaluating ischemic tolerance to ICA occlusion during surgery. The cutoff value of MEP amplitude was a > 80% reduction.

Mathis JM, Barr JD, Jungreis CA, Yonas H, Sekhar LN, Vincent D, Pentheny SL, Horton JA. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. AJNR Am J Neuroradiol. 1995;16(4):749–54.PubMedPubMedCentral

Legatt AD. Current practice of motor evoked potential monitoring: results of a survey. J Clin Neurophysiol. 2002;19:454–60. https://doi.org/10.1097/00004691-200210000-00008.CrossRefPubMed

Legatt AD, Emerson RG. Motor evoked potential monitoring–it's about time. J Clin Neurophysiol. 2002;19:383–6. https://doi.org/10.1097/00004691-200210000-00001.CrossRefPubMed

Horiuchi K, Suzuki K, Sasaki T, Matsumoto M, Sakuma J, Konno Y, Oinuma M, Itakura T, Kodama N. Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms. J Neurosurg. 2005;103(2):275–83. https://doi.org/10.3171/jns.2005.103.2.0275.CrossRefPubMed

Lesser RP, Raudzens P, Lüders H, Nuwer MR, Goldie WD, Morris HH 3rd, Dinner DS, Klem G, Hahn JF, Shetter AG, et al. Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potential. Ann Neurol. 1986;19(1):22–5. https://doi.org/10.1002/ana.410190105.CrossRefPubMed

Neuloh G, Schramm J. Monitoring of motor evoked potential compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg. 2004;100(3):389–99. https://doi.org/10.3171/jns.2004.100.3.0389.CrossRefPubMed

Weinzierl MR, Reinacher P, Glisbach JM, Rohde V. Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra- and postoperative data in a series of 69 operations. Neurosurg Rev. 2007;30(2):109–16. https://doi.org/10.1007/s10143-006-0061-5.CrossRefPubMed

Kombos T, Suess O, Ciklatekerlio O, Brock M. Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex. J Neurosurg. 2001;95(4):608–14. https://doi.org/10.3171/jns.2001.95.4.0608.CrossRefPubMed

Malcharek MJ, Ulkatan S, Marinò V, Geyer M, Lladó-Carbó E, Perez-Fajardo G, Arranz-Arranz B, Climent J, Aloj F, Franco E, Chiacchiari L, Kulpok A, Sablotzki A, Hennig G, Deletis V. Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: a multicenter study of 600 patients. Clin Neurophysiol. 2013;124(5):1025–30. https://doi.org/10.1016/j.clinph.2012.10.014.CrossRefPubMed

10.

Uchino H, Nakamura T, Kuroda S, Houkin K, Murata J, Saito H. Intraoperative dual monitoring during carotid endarterectomy using motor evoked potentials and near-infrated spectroscopy. World Neurosurg. 2012;78(6):651–7. https://doi.org/10.1016/j.wneu.2011.10.039.CrossRefPubMed

11.

Kombos T, Kopetsch O, Suess O, Brock M. Does preoperative paresis influence intraoperative monitoring of the motor cortex? J Clin Neurophysiol. 2003;20(2):129–34. https://doi.org/10.1097/00004691-200304000-00007.CrossRefPubMed

12.

Tanaka S, Kobayashi I, Sagiuchi T, et al. Compensation of intraoperative transcranial motor-evoked potential monitoring by compound muscle action potential after peripheral nerve stimulation. J Clin Neurophysiol. 2005;22:271–4. https://doi.org/10.1097/00004691-200304000-00007.CrossRefPubMed

13.

Amantini A, Bartelli M, de Scisciolo G, Lombardi M, Macucci M, Rossi R, Pratesi C, Pinto F. Monitoring of somatosensory evoked potentials during carotid endarterectomy. J Neurol. 1992;239(5):241–7. https://doi.org/10.1007/bf00810344.CrossRefPubMed

14.

Fava E, Bortolani E, Ducati A, Schieppati M. Role of SEP in identifying patients requiring temporary shunt during carotid endarterectomy. Electroencephalogr Clin Neurophysiol. 1992;84(5):426–32. https://doi.org/10.1016/0168-5597(92)90029-b.CrossRefPubMed

15.

Schneider JR, Novak KE. Carotid endarterectomy with routine electroencephalography and selective shunting. Semin Vasc Surg. 2004;17(3):230–5. https://doi.org/10.1016/s0895-7967(04)00046-8.CrossRefPubMed

16.

Sundt TM Jr, Ebersold MJ, Sharbrough FW, Piepgras DG, Marsh WR, Messick JM Jr. The risk-benefit ratio of intraoperative shunting during carotid endarterectomy. Ann Surg. 1986;203(2):196–204. https://doi.org/10.1097/00000658-198602000-00014.CrossRefPubMedPubMedCentral

17.

Markand ON, Dilley RS, Moorthy SS, Warren C Jr. Monitoring of somatosensory evoked responses during carotid endarterectomy. Arch Neurol. 1984;41(4):375–8. https://doi.org/10.1001/archneur.1984.04050160037012.CrossRefPubMed

18.

Sbarigia E, Schioppa A, Misuraca M, Panico MA, Battocchio C, Maraglino C, Speziale F, Fiorani P. Somatosensory evoked potentials versus locoregional anaesthesia in the monitoring of cerebral function during carotid artery surgery: preliminary results of a prospective study. Eur J Vasc Endovasc. 2001;21(5):413–6. https://doi.org/10.1053/ejvs.2001.1342.CrossRef

19.

Friedman WA, Chadwick GM, Verhoeven FJ, Mahla M, Day AL. Monitoring of somatosensory evoked potentials during surgery for middle cerebral artery aneurysms. Neurosurgery. 1991;29(1):83–8. https://doi.org/10.1097/00006123-199107000-00014.CrossRefPubMed

20.

Holland NR. Subcortical strokes from intracranial aneursym surgery: implications for intraoperative neuromonitoring. J Clin Neurophysiol. 1998;15(5):439–46. https://doi.org/10.1097/00004691-199809000-00008.CrossRefPubMed

21.

Diedler J, Sykora M, Bast T, Poli S, Veltkamp R, Mellado P, Steiner T, Rupp A. Quantitative EEG correlates of low cerebral perfusion in severe stroke. Neurocrit Care. 2009;11(2):210–6. https://doi.org/10.1007/s12028-009-9236-6.CrossRefPubMed

22.

Nagata K, Tagawa K, Hiroi S, Shishido F, Uemura K. Electroencephalographic correlates of blood flow and oxygen metabolism provided by positron emission tomography in patients with cerebral infarction. Electroencephalogr Clin Neurophysiol. 1989;72(1):16–30. https://doi.org/10.1016/0013-4694(89)90027-8.CrossRefPubMed

23.

Schneider AL, Jordan KG. Regional attenuation without delta (RAWOD): a distinctive EEG pattern that can aid in the diagnosis and management of severe acute ischemic stroke. Am J Electroneurodiagnostic Technol. 2005;45(2):102–17.CrossRef

24.

Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973;4(4):674–83. https://doi.org/10.1161/01.str.4.4.674.CrossRefPubMed

25.

Sundt TM Jr, Sharbrough FW, Anderson RE, Michenfelder JD. Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. 1974. J Neurosurg. 2007;107(4):887–97. https://doi.org/10.3171/JNS-07/10/0887.CrossRefPubMed

26.

Astrup J, Symon L, Branston NM, Lassen NA. Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke. 1977;8(1):51–7. https://doi.org/10.1161/01.str.8.1.51.CrossRefPubMed

27.

Branston NM, Symon L, Crockard HA, Pasztor E. Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol. 1974;45(2):195–208. https://doi.org/10.1016/0014-4886(74)90112-5.CrossRefPubMed

28.

Symon L. The relationship between CBF, evoked potentials and the clinical features in cerebral ischaemia. Acta Neurol Scand Suppl. 1980;78:175–90.PubMed

29.

Boysen G, Engel HC, Pistolese GR, Fiorani P, Lassen NA. On the critical lower levels of cerebral blood flow in man with particular reference to carotid surgery. Circulation. 1974;49(6):1023–5. https://doi.org/10.1161/01.cir.49.6.1023.CrossRefPubMed

30.

Yonas H, Sehkar L, Johnson DW, Gur D. Determination of irreversible ischemia by Xenon-enhanced computed tomography monitoring of cerebral blood flow in patients with symptomatic vasospasm. Neurosurgery. 1989;24(3):368–72. https://doi.org/10.1227/00006123-198903000-00010.CrossRefPubMed

31.

Wells BA, Keats AS, Cooley DA. Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. Surgery. 1963;54:216–23.PubMed

Title: Motor evoked potential monitoring can evaluate ischemic tolerance to carotid artery occlusion during surgery
Authors: Yoshiaki Takamura
Yasushi Motoyama
Tsunenori Takatani
Yasuhiro Takeshima
Ryosuke Matsuda
Kentaro Tamura
Shuichi Yamada
Fumihiko Nishimura
Ichiro Nakagawa
Young-Su Park
Hiroyuki Nakase
Publication date: 01-10-2021
Publisher: Springer Netherlands
Keywords: Motor Evoked Potential
Somatosensory Evoked Potential
Carotid Endarterectomy
Motor Evoked Potential
Somatosensory Evoked Potential
Published in: Journal of Clinical Monitoring and Computing / Issue 5/2021
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-020-00573-0

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