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Somatosensory evoked potentials after decompressive craniectomy for traumatic brain injury

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Abstract

Somatosensory evoked potentials (SSEPs) are used for neuroprognosis after severe traumatic brain injury (TBI). However decompressive craniectomy (DC), involving removal of a portion of the skull to alleviate elevated intracranial pressure, is associated with an increase in SSEP amplitude. Accordingly, SSEPs are not available for neuroprognosis over the hemisphere with DC. We aim to determine the degree to which SSEP amplitudes are increased in the absence of cranial bone. This will serve as a precursor for translation to clinically prognostic ranges. Intra-operative SSEPs were performed before and after bone flap replacement in 22 patients with severe TBI. SSEP measurements were also performed in a comparison non-traumatic group undergoing craniotomy for tumor resection. N20/P25 amplitudes and central conduction time were measured with the bone flap in (BI) and out (BO). Linear regressions, adjusting for skull thickness and study arm, were performed to evaluate the contribution of bone presence to SSEP amplitudes. Latencies were not different between BO or BI trials in either group. Mean N20/P25 amplitudes recorded with BO were statistically different (p = 0.0001) from BI in both cohorts, showing an approximate doubling in BO amplitudes. For contralateral–ipsilateral montages r2 was 0.28 and for frontal pole montages r2 was 0.62. Cortical SSEP amplitudes are influenced by the presence of cortical bone as is particularly evident in frontal pole montages. Larger, longitudinal trials to assess feasibility of neuroprognosis over the hemisphere with DC in severe TBI patients are warranted.

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Acknowledgements

The authors wish to thank the neurophysiology monitoring staff, Godwin Anthonipillai and Michael Vandenberk, and The Division of Neurosurgery at Sunnybrook HSC for performing SSEP testing. The authors would like to acknowledge the statistical support of Alex Kiss, PhD, Sunnybrook Health Sciences Centre, Biostatistician, and the research discussions with Dr. David Houlden, Neurophysiologist, The Ottawa Hospital, prior to study design.

Funding

Funding was provided by Sunnybrook Division of Neurosurgery, AEF Fund.

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Authors and Affiliations

  1. Division of Neurosurgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Allison Bethune, Nadia Scantlebury, Victor Yang, Todd Mainprize, Mahmood Fazl, Farhad Pirouzmand, Leodante da Costa & Nicolas Phan

  2. Department of Surgical Neuromonitoring, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Ekaterina Potapova & Nicole Dinn

  3. Department of Surgery, University of Toronto, 5th Floor, 149 College Street, Toronto, ON, M5T 1P5, Canada

    Victor Yang, Todd Mainprize, Mahmood Fazl, Farhad Pirouzmand, Leodante da Costa & Nicolas Phan

  4. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Martin Chapman

  5. Department of Anaesthesia, University of Toronto, Room 1200, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada

    Martin Chapman

  6. Division of Neurosurgery, Cabell Huntington Hospital, Marshall University, 1600 Medical Center Dr., Suite B577, Huntington, WV, 25701, USA

    Nicolas Phan

Authors
  1. Allison Bethune
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  2. Nadia Scantlebury
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  3. Ekaterina Potapova
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  4. Nicole Dinn
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  5. Victor Yang
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  6. Todd Mainprize
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  7. Mahmood Fazl
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  8. Farhad Pirouzmand
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  9. Leodante da Costa
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  10. Martin Chapman
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  11. Nicolas Phan
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Corresponding author

Correspondence to Nicolas Phan.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bethune, A., Scantlebury, N., Potapova, E. et al. Somatosensory evoked potentials after decompressive craniectomy for traumatic brain injury. J Clin Monit Comput 32, 881–887 (2018). https://doi.org/10.1007/s10877-017-0083-2

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  • DOI: https://doi.org/10.1007/s10877-017-0083-2

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