title: Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring.
abstract: Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Purger
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA aferoze@stanford.edu.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Feroze
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA Department of Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Choudhri
authors.affiliation: Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Dodd
mesh_terms: D001488:Basilar Artery; D002533:Cerebral Angiography; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology*; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012008:Recurrence; D019233:Retreatment
keywords: Neuromonitoring; limb ischemia; motor evoked potentials; somatosensory evoked potentials