caa a22 4500 606216995 CHVBK 20210128101106.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00701-015-2568-4 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2568-4 Application of intraoperative motor evoked potential monitoring during giant internal carotid artery aneurysm surgery using prolonged temporary occlusion [Elektronische Daten] [Jianping Song, Liqin Lang, Wei Zhu, Yuxiang Gu, Bin Xu, Jiajun Cai, Qi Yue, Geng Xu, Liang Chen, Ying Mao] Background: Clipping and bypass surgery are common therapeutic options for the management of giant internal carotid artery (ICA) aneurysms. However, potential ischemic risks may be exaggerated by prolonged temporary occlusion (PTO) during the surgery. Monitoring motor-evoked potentials (MEPs) is a sensitive technique for detecting potential ischemia intraoperatively. This preliminary study was designed to evaluate the effectiveness of applying MEP monitoring during giant ICA aneurysm surgery using PTO. Methods: From July 2009 to July 2012, 11 patients with giant ICA aneurysms who could not pass the preoperative hemodynamic evaluations were enrolled in this study. MEP monitoring was utilized intraoperatively in all cases. Clipping was performed if there were no significant MEP changes under PTO. A variant extracranial-to-intracranial (EC-IC) bypass was performed if there was reproducible loss of MEP signals after PTO or unclippable anatomic features. Results: Five patients underwent clipping alone and six underwent bypass. There were no significant differences in baseline clinical data between the two groups. The overall percentage of patients with good outcomes (Glasgow Outcome Score ≥4) improved from 72.7% (8/11) postoperatively to 90.9% (10/11) after 26.0 ± 9.5months of follow-up. There were no significant differences between the clipping and bypass groups regarding short- and long-term outcomes (p = 0.545 and p = 1.000). Conclusions: MEP monitoring is useful for evaluating the safety of PTO, surgical strategy, and outcomes of giant ICA aneurysm surgery. Direct clipping during safe PTO under intraoperative MEP monitoring is applicable for giant ICA aneurysms. Its use achieved favorable outcomes by indicating the need for bypass surgery. Springer-Verlag Wien, 2015 Intracranial aneurysm nationallicence Surgery nationallicence Internal carotid artery nationallicence Clipping nationallicence Bypass nationallicence Motor evoked potential nationallicence Song Jianping Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Lang Liqin Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Zhu Wei Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Gu Yuxiang Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Xu Bin Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Cai Jiajun Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Yue Qi Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Xu Geng Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Chen Liang Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Mao Ying Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1833-1840 0001-6268 157:11<1833 2015 157 701 https://doi.org/10.1007/s00701-015-2568-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2568-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Song Jianping Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Lang Liqin Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Zhu Wei Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Gu Yuxiang Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Xu Bin Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Cai Jiajun Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Yue Qi Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Xu Geng Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Chen Liang Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 700 1- Mao Ying Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, 200040, Shanghai, China aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1833-1840 0001-6268 157:11<1833 2015 157 701