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<meta name="DC.Title" content="Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3017" />
<meta name="DC.Date" content="2012-10-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures.

MATERIALS AND METHODS: We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events.

RESULTS: Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits.

CONCLUSIONS: These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.

BAER
:   brain stem auditory evoked response
EEG
:   electroencephalogram
EVD
:   external ventricular drain
GOS
:   Glasgow outcome score
MEP
:   motor-evoked potential
SSEP
:   somatosensory-evoked potential
TcMEP
:   transcranial motor-evoked potential
TIVA
:   total intravenous anesthetic" />
<meta name="DC.Contributor" content="T.G. Horton" />
<meta name="DC.Contributor" content="M. Barnes" />
<meta name="DC.Contributor" content="S. Johnson" />
<meta name="DC.Contributor" content="P.C. Kalapos" />
<meta name="DC.Contributor" content="A. Link" />
<meta name="DC.Contributor" content="K.M. Cockroft" />
<meta name="article:published_time" content="2012-10-01" />
<meta name="article:section" content="Functional" />
<meta name="citation_title" content="Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.&lt;/p&gt;" />
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<meta name="twitter:title" content="Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/33/9.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures.

MATERIALS AND METHODS: We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events.

RESULTS: Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits.

CONCLUSIONS: These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.

BAER
:   brain stem auditory evoked response
EEG
:   electroencephalogram
EVD
:   external ventricular drain
GOS
:   Glasgow outcome score
MEP
:   motor-evoked potential
SSEP
:   somatosensory-evoked potential
TcMEP
:   transcranial motor-evoked potential
TIVA
:   total intravenous anesthetic" />
<meta name="og-title" property="og:title" content="Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/33/9/1825" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures.

MATERIALS AND METHODS: We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events.

RESULTS: Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits.

CONCLUSIONS: These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.

BAER
:   brain stem auditory evoked response
EEG
:   electroencephalogram
EVD
:   external ventricular drain
GOS
:   Glasgow outcome score
MEP
:   motor-evoked potential
SSEP
:   somatosensory-evoked potential
TcMEP
:   transcranial motor-evoked potential
TIVA
:   total intravenous anesthetic" />
<meta name="og-type" property="og:type" content="article" />
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<script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Feasibility and Efficacy of Transcranial Motor-Evoked Potential Monitoring in Neuroendovascular Surgery","hwUrl":"http://ajnr-stage2.stage.highwire.org/content/33/9/1825","hwPath":"/content/33/9/1825.abstract","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"yes","hwEntitled":"no"},"content":{"hwIssueDate":"2012-10-01","hwIssueDateTime":"2012-10-01 00:00:00","hwPublicationDate":"2012-10-08","hwPublicationDateTime":"2012-10-08 07:32:05","hwNlmArticleType":"research-article","hwDOI":"10.3174/ajnr.A3017","hwAuthors":"T.G. Horton,M. Barnes,S. Johnson,P.C. Kalapos,A. Link,K.M. Cockroft","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1936-959X","hwPissn":"0195-6108","hwVolume":"33","hwIssue":"9","hwArticleType":"Functional","hwTabView":"main_tab","hwViewType":"abstract","hwAccessType":"Free","hwOpenAccess":"no","hwFreeAccess":"yes","hwTaxonomy":"","hwCorpusCode":"ajnr","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"ajnr;33/9/1825","hwFirstPage":"1825","hwLastPage":"1831","hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"American Journal of Neuroradiology: 33 (9)","hwElectronicPubDate":"2012-10-08","hwElectronicPubDateTime":"2012-10-08 07:32:05"}});
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">T.G. Horton</span>, <span class="highwire-citation-author" data-delta="1">M. Barnes</span>, <span class="highwire-citation-author" data-delta="2">S. Johnson</span>, <span class="highwire-citation-author" data-delta="3">P.C. Kalapos</span>, <span class="highwire-citation-author" data-delta="4">A. Link</span> and <span class="highwire-citation-author" data-delta="5">K.M. Cockroft</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1825-1831; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3017 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12086--6855031458" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">T.G. Horton </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (T.G.H., P.C.K., K.M.C.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.G.%2BHorton%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Horton%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AT.G.%2BHorton%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Barnes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Impulse Monitoring, Inc. 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Link </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Impulse Monitoring, Inc. (M.B., S.J., A.L.), Columbia, Maryland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BLink%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Link%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.%2BLink%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">K.M. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Neurophysiological monitoring for neuroendovascular procedures typically involves EEG and SSEP monitoring via cutaneous electrodes. MEP monitoring has been used less frequently because, traditionally, this has required subdural electrode placement. With the advent of transcutaneous techniques, MEP monitoring use has increased. However, little has been published regarding the use of this technique in therapeutic neuroendovascular procedures. The purpose of this study was therefore to determine whether TcMEP monitoring is feasible and efficacious in therapeutic neuroendovascular procedures.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> We retrospectively reviewed our data base of therapeutic neuroendovascular procedures performed with the use of TcMEP monitoring. We specifically determined the incidence of TcMEP changes compared with changes in either SSEP or EEG. We then correlated these changes to actual adverse neurologic events.</p>
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<p id="p-3"><strong>RESULTS:</strong> Although TcMEP monitoring was technically successful in all of the 140 patients in which it was attempted, we observed significant changes in TcMEP signals in only 1 patient. This patient experienced changes involving all 3 monitoring modalities after intraprocedural aneurysm rupture. In contrast, changes in SSEP tracings alone were found in 9 patients. Of these, 2 patients were known to be moribund before their procedures and neither recovered. Among the remaining 7 patients, temporary SSEP changes tended to correlate with temporary neurologic deficits, while permanent changes were associated with permanent or long-lasting deficits.</p>
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<p id="p-4"><strong>CONCLUSIONS:</strong> These results suggest that TcMEP monitoring is feasible in therapeutic neuroendovascular procedures. However, it appears that the addition of TcMEP monitoring provides no added benefit to SSEP and EEG monitoring alone.</p>
</div></div><div class="section glossary" id="glossary-1">
<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">BAER<span class="def-item-dt-sep"></span></dt><dd>brain stem auditory evoked response<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">EEG<span class="def-item-dt-sep"></span></dt><dd>electroencephalogram<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">EVD<span class="def-item-dt-sep"></span></dt><dd>external ventricular drain<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">GOS<span class="def-item-dt-sep"></span></dt><dd>Glasgow outcome score<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">MEP<span class="def-item-dt-sep"></span></dt><dd>motor-evoked potential<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">SSEP<span class="def-item-dt-sep"></span></dt><dd>somatosensory-evoked potential<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">TcMEP<span class="def-item-dt-sep"></span></dt><dd>transcranial motor-evoked potential<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">TIVA<span class="def-item-dt-sep"></span></dt><dd>total intravenous anesthetic</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2012 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/33/9/1825.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 33</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2012 </div></div>
      
      
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