title: [Usefulness and Problems of Intraoperative Monitoring for Unruptured Aneurysm Surgery with the Motor Evoked Potential].
abstract: It has been pointed out that the motor evoked potential(MEP)with a subdural electrode is useful in the intraoperative monitoring for unruptured aneurysm surgery. However, in some cases, we experienced postoperative ischemic complications despite evaluating the motor function via MEP monitoring. Herein, we have reported the usefulness and problems of intraoperative monitoring with MEP to evaluate brain dysfunction caused by insufficiency of cerebral blood flow. Out of 279 aneurysm surgery procedures, we performed MEP monitoring in 142 cases and successfully recorded in 126 cases. We compared the ischemic complication rate of the group for which MEP was monitored with that of the group for which MEP was not monitored. The whole ischemic complication rate was decreased in the group that underwent MEP monitoring. Thus, it was suggested that MEP monitoring was useful for avoiding ischemic complications. In internal carotid artery aneurysms, the amplitude of MEP changed and recovered in 2 cases and disappeared in one case. In anterior cerebral artery aneurysms, the amplitude of MEP changed and recovered in 2 cases. In middle cerebral artery aneurysms, the amplitude of MEP changed and recovered in 5 cases. We could avoid ischemic complications by intraoperative MEP monitoring in many cases. However, in some cases, we found ischemic complications that were not detected by MEP monitoring with a subdural electrode. In these cases, transcranial stimulation in combination with subdural electrode might be effective in avoiding ischemic complications that might occur after dural closure.
authors.affiliation: Department of Neurosurgery, The Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ishizaki
authors.forename: Otone
authors.initials: O
authors.lastname: Endo
authors.forename: Kentaro
authors.initials: K
authors.lastname: Fujii
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Matsudaira
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okada
authors.forename: Nozomu
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Michiko
authors.initials: M
authors.lastname: Kitamura
authors.forename: Makiko
authors.initials: M
authors.lastname: Shibata
authors.forename: Masaya
authors.initials: M
authors.lastname: Higuchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Hirano
authors.forename: Chinari
authors.initials: C
authors.lastname: Furuichi
authors.forename: Akiyo
authors.initials: A
authors.lastname: Moroto
authors.forename: Maki
authors.initials: M
authors.lastname: Mita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Naohito
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004569:Electroencephalography; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative