Intraoperative vascular complications during 2278 cerebral endovascular procedures with multimodality IONM: relationship between signal change, complication, intervention and postoperative outcome.
Adult
Anesthesia, General
/ adverse effects
Endovascular Procedures
/ adverse effects
Evoked Potentials, Motor
/ physiology
Evoked Potentials, Somatosensory
/ physiology
Female
Humans
Intraoperative Complications
/ diagnostic imaging
Intraoperative Neurophysiological Monitoring
/ methods
Male
Middle Aged
Multimodal Imaging
/ methods
Neurosurgical Procedures
/ adverse effects
Retrospective Studies
Treatment Outcome
aneurysm
angiography
brain
complication
stroke
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
20
07
2020
revised:
04
11
2020
accepted:
07
11
2020
pubmed:
15
1
2021
medline:
12
5
2021
entrez:
14
1
2021
Statut:
ppublish
Résumé
Intraoperative neuromonitoring (IONM) is often used during cerebral endovascular procedures. To investigate the relationship between intraoperative vascular complications and IONM signal changes, and the impact of interventions on signal resolution and postoperative outcomes. A series of 2278 cerebral endovascular procedures conducted under general anesthesia and using electroencephalography and somatosensory evoked potential monitoring were retrospectively reviewed. A subset of 763 procedures also included motor evoked potentials (MEPs). IONM alerts were categorized as either a partial attenuation or complete loss of signal. Vascular complications were subcategorized as due to rupture, emboli, instrumentation, or vasospasm. Odds ratios (ORs) for new postoperative motor deficits were calculated and diagnostic accuracy was measured using sensitivity, specificity, and likelihood ratios. The overall incidence of new postoperative motor deficit was 1.2%; 20.4% in cases with an IONM alert and 0.09% in cases without an alert. Relative to procedures with no alerts, odds of a new deficit increased if there was partial signal attenuation (OR=210.9, 95% CI 44.3 to 1003.5, p<0.0001) and increased further with complete loss of signal (OR=1437.3, 95% CI 297.3 to 6948.2, p<0.0001). Relative to procedures with unresolved alerts, odds of a new deficit decreased if the alert was fully resolved (OR=0.039, 95% CI 0.005 to 0.306, p<0.002). Procedures using MEPs had slightly higher sensitivity (92.3% vs 85.7%) but slightly lower specificity (96.7% vs 98.2%). An IONM alert associated with an arterial complication is associated with a dramatic increase in odds of a new postoperative deficit; however, if there is resolution of the alert prior to closure, odds of a new deficit decrease significantly.
Sections du résumé
BACKGROUND
BACKGROUND
Intraoperative neuromonitoring (IONM) is often used during cerebral endovascular procedures.
OBJECTIVE
OBJECTIVE
To investigate the relationship between intraoperative vascular complications and IONM signal changes, and the impact of interventions on signal resolution and postoperative outcomes.
METHODS
METHODS
A series of 2278 cerebral endovascular procedures conducted under general anesthesia and using electroencephalography and somatosensory evoked potential monitoring were retrospectively reviewed. A subset of 763 procedures also included motor evoked potentials (MEPs). IONM alerts were categorized as either a partial attenuation or complete loss of signal. Vascular complications were subcategorized as due to rupture, emboli, instrumentation, or vasospasm. Odds ratios (ORs) for new postoperative motor deficits were calculated and diagnostic accuracy was measured using sensitivity, specificity, and likelihood ratios.
RESULTS
RESULTS
The overall incidence of new postoperative motor deficit was 1.2%; 20.4% in cases with an IONM alert and 0.09% in cases without an alert. Relative to procedures with no alerts, odds of a new deficit increased if there was partial signal attenuation (OR=210.9, 95% CI 44.3 to 1003.5, p<0.0001) and increased further with complete loss of signal (OR=1437.3, 95% CI 297.3 to 6948.2, p<0.0001). Relative to procedures with unresolved alerts, odds of a new deficit decreased if the alert was fully resolved (OR=0.039, 95% CI 0.005 to 0.306, p<0.002). Procedures using MEPs had slightly higher sensitivity (92.3% vs 85.7%) but slightly lower specificity (96.7% vs 98.2%).
CONCLUSIONS
CONCLUSIONS
An IONM alert associated with an arterial complication is associated with a dramatic increase in odds of a new postoperative deficit; however, if there is resolution of the alert prior to closure, odds of a new deficit decrease significantly.
Identifiants
pubmed: 33443128
pii: neurintsurg-2020-016604
doi: 10.1136/neurintsurg-2020-016604
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
378-383Informations de copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: AKS notes stock ownership in KPSC Holdings/Specialty Care and has received honoraria from the American Society of Neurophysiological Monitoring and the Overlook Foundation. WK reports personal consulting fees from Stryker Neurovascular, small stock option interest in Route 92 Medical, outside the submitted work; In addition, WK has a patent with Route 92 Medical pending.