دورية أكاديمية
أعرض في EDS

Real-Time Evaluation of Anterior Choroidal Artery Patency During Aneurysm Clipping.

التفاصيل البيبلوغرافية
العنوان: Real-Time Evaluation of Anterior Choroidal Artery Patency During Aneurysm Clipping.
المؤلفون: Felbaum D; Neurosurgery, Medstar Georgetown University Hospital., Zhao DY; Neurosurgery, Medstar Georgetown University Hospital., Nayar VV; Neurosurgery, Medstar Georgetown University Hospital., Kalhorn CG; Neurosurgery, Medstar Georgetown University Hospital., McGrail KM; Neurosurgery, Medstar Georgetown University Hospital., Mandir AS; Neurology, Medstar Georgetown University Hospital., Minahan RE; Neurology, Medstar Georgetown University Hospital.
المصدر: Cureus [Cureus] 2016 Feb 14; Vol. 8 (2), pp. e495. Date of Electronic Publication: 2016 Feb 14.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: Electronic Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Palo Alto, CA : Cureus, Inc.
مستخلص: Inadvertent occlusion of the anterior choroidal artery during aneurysm clipping can cause a disabling stroke in minutes. We evaluate the clinical utility of direct cortical motor evoked potential (MEP) monitoring during aneurysm clipping, as a real-time assessment of arterial patency, prior to performing indocyanine green videoangiography.   Direct cortical MEPs were recorded in seven patients undergoing surgery for aneurysms that involved or abutted the anterior choroidal artery. The aneurysms clipped in those seven patients included four anterior choroidal artery aneurysms and six posterior communicating artery aneurysms. Serial MEP recordings were performed during the intradural dissection, aneurysm exposure, and clip placement. A significant change in MEPs after clip placement would prompt immediate inspection and removal or repositioning of the clip. If the clip placement appeared satisfactory and MEP recordings were stable, then an intraoperative indocyanine green videoangiogram was performed to confirm obliteration of the aneurysm and patency of the arteries.  Seven patients underwent successful clipping of anterior choroidal artery aneurysms and posterior communicating artery aneurysms using direct cortical MEP monitoring, with good clinical and radiographic outcomes. In six patients, no changes in MEP amplitudes were observed following permanent clip placement. In one patient, a profound decrease in MEP amplitude occurred 220 seconds after placement of a permanent clip on a large posterior communicating aneurysm. An inspection revealed that the anterior choroidal artery was kinked. The clip was immediately removed, and the MEP signals returned to baseline shortly thereafter. A clip was then optimally placed, and the patient awoke without neurologic deficit.  Direct cortical MEPs are a useful adjunct to standard electrophysiologic monitoring in aneurysm surgery, particularly when the anterior choroidal artery or lenticulostriate arteries are at risk. When these arteries are occluded, infarction may occur before the occlusion is detected by indocyanine green videoangiography or intraoperative angiography. The use of MEPs allows real-time detection of ischemia to subcortical motor pathways.
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فهرسة مساهمة: Keywords: aneurysm; anterior choroidal aneurysm; intraoperative monitoring; motor evoked potentials
تواريخ الأحداث: Date Created: 20160326 Date Completed: 20160325 Latest Revision: 20201001
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC4792636
DOI: 10.7759/cureus.495
PMID: 27014529
قاعدة البيانات: MEDLINE
الوصف
تدمد:2168-8184
DOI:10.7759/cureus.495