%0 Journal Article
%T Intraoperative neuromonitoring as real-time diagnostic for cerebral ischemia in endovascular treatment of ruptured brain aneurysms.
%A Al-Qudah AM
%A Thirumala PD
%A Anetakis KM
%A Crammond DJ
%A Algarni SA
%A AlMajali M
%A Shandal V
%A Gross BA
%A Lang M
%A Bhatt NR
%A Al-Bayati AR
%A Nogueira RG
%A Balzer JR
%J Clin Neurophysiol
%V 161
%N 0
%D 2024 May 27
%M 38452426
%F 4.861
%R 10.1016/j.clinph.2024.02.024
%X OBJECTIVE: To evaluate the diagnostic accuracy of intraoperative neurophysiological monitoring (IONM) during endovascular treatment (EVT) of ruptured intracranial aneurysms (rIA).
METHODS: IONM and clinical data from 323 patients who underwent EVT for rIA from 2014-2019 were retrospectively reviewed. Significant IONM changes and outcomes were evaluated based on visual review of data and clinical documentation.
RESULTS: Of the 323 patients undergoing EVT, significant IONM changes were noted in 30 patients (9.29%) and 46 (14.24%) experienced postprocedural neurological deficits (PPND). 22 out of 30 (73.33%) patients who had significant IONM changes experienced PPND. Univariable analysis showed changes in somatosensory evoked potential (SSEP) and electroencephalogram (EEG) were associated with PPND (p-values: <0.001 and <0.001, retrospectively). Multivariable analysis showed that IONM changes were significantly associated with PPND (Odd ratio (OR) 20.18 (95%CI:7.40-55.03, p-value: <0.001)). Simultaneous changes in both IONM modalities had specificity of 98.9% (95% CI: 97.1%-99.7%). While sensitivity when either modality had a change was 47.8% (95% CI: 33.9%-62.0%) to predict PPND.
CONCLUSIONS: Significant IONM changes during EVT for rIA are associated with an increased risk of PPND.
CONCLUSIONS: IONM can be used confidently as a real time neurophysiological diagnostic guide for impending neurological deficits during EVT treatment of rIA.