title: Somatosensory evoked potential changes in neuroendovascular procedures: incidence and association with clinical outcome in 873 patients.
abstract: BACKGROUND
  Neurophysiological monitoring is routinely used during neurosurgical procedures. Use of neurophysiological monitoring has extended to neuroendovascular procedures, but evidence of its impact on clinical outcome in this arena is limited.
  
  
  OBJECTIVE
  To report the incidence of significant intraoperative somatosensory evoked potential (SSEP) changes during neuroendovascular surgery and to correlate SSEP changes with clinical outcomes.
  
  
  METHODS
  Patients who underwent neuroendovascular surgery at our institution between 2011 and 2013 were included in the analysis. Medical charts and imaging studies were reviewed retrospectively for sex, age, lesion type and size, clinical presentation, type of endovascular procedure, duration of SSEP change, reversibility of SSEP change, incidence of intraoperative complications and related mortalities, presence of new infarction within 72 hours of intervention, and discharge outcome.
  
  
  RESULTS
  Of 873 consecutive patients, 52 (6%) had clinically significant intraoperative SSEP changes. Twenty-four patients (46%) had SSEP changes that were corrected, and 28 patients (54%) had changes that were not reversed before the end of surgery. Both decreased duration and reversal of SSEP changes were associated with a lower incidence of postoperative infarction and more favorable clinical outcome on discharge. The positive predictive value of an irreversible SSEP change for postoperative infarction in our study was 21%, and the negative predictive value was 83%.
  
  
  CONCLUSIONS
  The approximate incidence of SSEP changes is 6% during neuroendovascular procedures. Rapid reversal of SSEP changes is associated with better outcomes. SSEP monitoring may be a valuable tool for preventing complications after neuroendovascular interventions.
authors: *Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; §Sentient Medical Systems, Hunt Valley, Maryland; and ¶Department of Neurosurgical Anesthesia, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors: Jessica L H
authors: JL
authors: Phillips
authors: Nohra
authors: N
authors: Chalouhi
authors: Pascal
authors: P
authors: Jabbour
authors: Robert M
authors: RM
authors: Starke
authors: Cory D
authors: CD
authors: Bovenzi
authors: Robert H
authors: RH
authors: Rosenwasser
authors: W Bryan
authors: WB
authors: Wilent
authors: Victor M
authors: VM
authors: Romo
authors: Stavropoula I
authors: SI
authors: Tjoumakaris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome