title: Implementation of Intraoperative Neurophysiological Monitoring during Endovascular Procedures in the Central Nervous System.
abstract: OBJECTIVE
  Intraoperative monitoring (IOM) has been used in different surgical disciplines since the 1980s. Nonetheless, regular routine use of IOM in interventional neuroradiology units has only been reported in a few centers. The aim of this study is to report our experience, 1 year after deciding to implement standardized IOM during endovascular treatment of vascular abnormalities of the central nervous system.
  
  
  METHODS
  Basic recordings included somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs). Corticobulbar motor-evoked potentials and flash-visual-evoked potentials were also recorded depending on the topography of the lesion. Intra-arterial provocative tests (PTs) with amobarbital and lidocaine were also performed. All patients except 1 were under total intravenous anesthesia. Clinical outcome was assessed prospectively and correlated with IOM events.
  
  
  RESULTS
  Twelve patients and 15 procedures were monitored during the inclusion period. Significant IOM events were detected during 3 of the 15 procedures (20%). We observed temporary MEP changes in 2 cases which resolved after interruption of the embolization or application of corrective measures, leaving no postoperative neurological deficits. In 1 case, persistent SEP and MEP deterioration was detected secondary to a frontal hematoma, resulting in mild sensory-motor deficit in the right upper extremity after the procedure. Overall, 12 PTs (4 spinal cord and 8 brain abnormalities) were performed using lidocaine and sodium amytal injections. One positive result occurred after the injection of lidocaine. No false negatives were detected.
  
  
  CONCLUSIONS
  IOM may provide continuous real-time data about the functional status of eloquent areas and pathways of the central nervous system in patients under general anesthesia. It therefore allows us to detect early neurological damage in time to perform specific actions that may prevent irreversible neurological deficits.
authors.affiliation: Service of Neurology and Section of Interventional Neuroradiology, Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Martinez Piñeiro
authors.affiliation: Department of Anesthesiology, Germans Trias i Pujol University Hospital, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Cubells
authors.affiliation: Service of Neurology and Section of Interventional Neuroradiology, Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Garcia
authors.affiliation: Service of Neurology and Section of Interventional Neuroradiology, Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Castaño
authors.affiliation: Service of Neurology and Section of Interventional Neuroradiology, Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dávalos
authors.affiliation: Service of Neurology and Section of Interventional Neuroradiology, Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Coll-Canti
keywords: Central nervous system, vascular pathology; Endovascular treatment; Evoked potentials; Intraoperative neurophysiological monitoring; Provocative tests