title: Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms.
abstract: OBJECTIVE
  The usefulness of motor evoked potential (MEP) monitoring to detect blood flow insufficiency (BFI) in the cortical branches of the middle cerebral artery (MCA) and lenticulostriate arteries (LSAs) during MCA aneurysm surgery was investigated based on the correlation between MEP and somatosensory evoked potential (SEP) monitoring.
  
  
  METHODS
  Fifty-three patients with MCA aneurysms underwent surgery accompanied by intraoperative MEP and SEP monitoring. There was no postoperative motor paresis in 43 patients in whom MEP and SEP results remained unchanged. In the other 10 patients, nine manifested transient MEP changes; in five of these, SEP changes did not occur. The transient MEP changes were thought to be attributable to BFI of the MCA cortical branches in two patients, the LSA in three, and either the MCA branches or the LSA in four patients. Of these nine patients, six did not present with postoperative motor paresis; transient motor paresis was recognized in the other three. In the 10th patient, MEP waves disappeared and did not recover. This patient's SEPs remained at 70% of the control level, and he developed severe hemiparesis. A postoperative computerized tomography scan revealed a new low-density area in the corona radiata and putamen.
  
  
  CONCLUSIONS
  Blood flow insufficiency in both the LSA and MCA cortical branches that perfuse the corticospinal tract can be detected by intraoperative MEP monitoring. Somatosensory evoked potential monitoring is not reliable enough to detect BFI in the MCA branches and the LSAs.
authors.affiliation: Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Horiuchi
authors.forename: Kyouicm
authors.initials: K
authors.lastname: Suzuki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
authors.forename: Masato
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Jun
authors.initials: J
authors.lastname: Sakuma
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Konno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oinuma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Itakura
authors.forename: Namio
authors.initials: N
authors.lastname: Kodama
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis; D002539:Cerebral Arterial Diseases / Q000601:surgery*; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity