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Evaluation of multimodal intraoperative neurophysiologic monitoring during supratentorial aneurysm surgery: a comparative study

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Abstract

The objective of this study is to determine the role of multimodal intraoperative neurophysiologic monitoring (IONM) in the overall outcome of intracranial aneurysms surgery, and the risk factors associated with ischemic complications. We grouped 268 ruptured and unruptured intracranial aneurysms surgically treated at our institution into 2 cohorts, based on the use of IONM (180; 67.16%) or non-use of IONM (88; 32.84%). The IONM technique used was multimodal: electroencephalogram (EEG), somatosensory evoked potentials (SSEPs), transcranial (TES), and direct cortical (DCS) stimulation motor evoked potentials (MEPs). There was a significant difference, with a reduction in perioperative strokes (p = 0.011) and better motor surgery-related outcome in the IONM group (p = 0.016). Independent risk factors identified for surgery ischemic complications were temporary clipping time ≥ 6′05″ (odds ratio [OR]: 3.03; 95% CI: 1.068–8.601; p = 0.037), aneurysm size ≥ 7.5 mm (OR: 2.65; 95% CI: 1.127–6.235; p = 0.026), and non-use of IONM (OR: 2.79; 95% CI: 1.171–6.636; p = 0.021). Conversely, aneurysm rupture was not detected as an independent risk factor (OR: 2.5; 95% CI: 0.55–4.55; p = 0.4). Longer temporary clipping time, larger aneurysm size, and the non-use of IONM could be considered as risk factors for ischemic complications during microsurgical clipping. A standardized designed protocol including multimodal IONM with DCS provides continuous information about blood supply and allows reduction of treatment-related morbidity. Multimodal IONM is a valuable technique in intracranial aneurysm surgery.

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Availability of data and material

Data supporting the findings of this study are available upon request from the corresponding author.

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Funding

This project was partially supported by a grant from the Instituto de Salud Carlos III through the project PI16/00392 (Co-funded by European Regional Development Fund: ERDF, a way to build Europe).

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Authors and Affiliations

  1. Intraoperative Neurophysiology Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Feixa Llarga s/n, Barcelona, 08907, Spain

    Júlia Miró Lladó, J. Pedro & I. Fernández-Conejero

  2. Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute-IDIBELL, Universitat de Barcelona, L’Hospitalet, 08097, Barcelona, Spain

    Júlia Miró Lladó

  3. Department of Neurosurgery, Hospital Universitari de BellvitgeL’Hospitalet de Llobregat, 08907, Barcelona, Spain

    P. López-Ojeda, A. Marnov & A. Gabarrós

  4. Department of Anesthesiology, Hospital Universitari de BellvitgeL’Hospitalet de Llobregat, 08907, Barcelona, Spain

    L. Contreras & L. Pariente

Authors
  1. Júlia Miró Lladó
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  2. P. López-Ojeda
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  3. J. Pedro
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  4. A. Marnov
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  5. L. Contreras
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  6. L. Pariente
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  7. A. Gabarrós
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  8. I. Fernández-Conejero
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Contributions

J.Miró: conceptualization, methodology, formal analysis, writing—original draft, and funding acquisition. P. López-Ojeda: conceptualization, resources, and writing—review. J. Pedro: data curation and writing—review and editing. A. Marnov: resources. L. Contreras: methodology and writing—review and editing. L. Pariente: writing—review and editing. A. Gabarrós: resources and supervision. I. Fernandez-Conejero: conceptualization, methodology, project administration, supervision, and writing—review and editing.

Corresponding author

Correspondence to Júlia Miró Lladó.

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This manuscript was reviewed and approved for publication by the Research Ethics Committee of Bellvitge University Hospital.

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Written informed consent was institutionally waived, as it was a retrospective analysis of usual everyday work.

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Miró Lladó, J., López-Ojeda, P., Pedro, J. et al. Evaluation of multimodal intraoperative neurophysiologic monitoring during supratentorial aneurysm surgery: a comparative study. Neurosurg Rev 45, 2161–2173 (2022). https://doi.org/10.1007/s10143-021-01710-2

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  • DOI: https://doi.org/10.1007/s10143-021-01710-2

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