Detection of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Using Motor Evoked Potentials

作者：Grossauer Stefan^*; Koeck Katharina; Kraschl Jakob; Olipitz Oliver; Hausegger Klaus A; Vince Giles H

来源：Neurosurgery, 2016, 78(2): 265-273.

DOI：10.1227/NEU.0000000000001040

• Intracranial aneurysm
• Motor evoked potentials
• Neurophysiological monitoring
• Subarachnoid hemorrhage
• Vasospasm

BACKGROUND:Early detection of vasospasm (VS) following aneurysmal subarachnoid hemorrhage (aSAH) is vital to trigger therapy and to prevent infarction and subsequent permanent neurological deficit. Although motor evoked potentials (MEPs) are a well-established method for intraoperative detection of cerebral VS and cerebral ischemia during aneurysm surgery, there are no studies investigating the diagnostic value of MEPs for detecting delayed VS following aSAH in an intensive care unit.OBJECTIVE:A prospective study was conceived to assess the diagnostic accuracy of MEPs in comparison with digital subtraction angiography.METHODS:MEP threshold changes were determined in patients both with and without angiographic VS following high-grade aSAHs. Sensitivity, specificity, and the positive and negative predictive values of significant MEP threshold increases, which indicate angiographic VS, were calculated.RESULTS:In all patients experiencing VS of the arteries supplying cerebral motor areas, a minimal MEP threshold increase of 50 mA (mean 66.25 mA) was observed, whereas a maximum MEP threshold increase of 30 mA was observed in patients without VS. Therefore, an increase from a baseline of 50 mA was considered significant and resulted in a sensitivity of 0.83, a specificity of 0.92, a positive predictive value of 0.83, and a negative predictive value of 0.92.CONCLUSION:VS following aSAH can be detected accurately by using MEPs. MEPs are a feasible bedside tool for online VS detection in an intensive care unit and, therefore, may complement existing diagnostic tools.ABBREVIATIONS:aSAH, aneurysmal subarachnoid hemorrhageDSA, digital subtraction angiographyICU, intensive care unitMEP, motor evoked potentialPCT, perfusion computed tomographyTCD, transcranial DopplerVS, vasospasm

• 出版日期2016-2