Related problems in induced potential monitoring in brain aneurysm clamping

Ref: Chung J, et alJNeurosurg2018 Mar 23:1-13doi: 10.3171/2017.8.JNS17791Thesomatic sensation and motion-induced potential (SEP and MEP) has been used to monitor and prevent ischemic complications in brain aneurysmIntraoperative induced potential (EP) monitoring can have suspicious false positive and false negative results, but its incidence and causes have not been confirmedJaewoo Chung of Neurosurgery at Mount Yanshan Medical Center in Seoul, South Korea, and other retrospective analyses showed an immediate correlation between motor weakness and EP monitoring to analyze false positive and false negative resultsThe paper was published online in March 2018 in J Neurosurgthe retrospective study collected data on 1,514 patients who performed cerebral aneurysm clamping under EP monitoring between January 2012 and April 2016 at the authors' clinical centres, as shown in Table 1The monitored EP amplitude level decreased to 50% or more below the baseline, which was marked as a significant change in EPtable 1Clinical data for 1514 patients1514 patients, 18 (1.19%) developed symptomatic infarction and 4 (0.26%) of symptomatic haemorrhageFifteen cases showed motor weakness, of which 10 were found during a motor function test immediately after surgeryEp monitoring results showed 15 (0.99%) false positives and 8 (0.53%) false negative (Tables 2, 3) In the operation of uncracked intracranial aneurysm, the sensitivity of the motion-induced potential was 0.10, the specificity was 0.94, the positive prediction value was 0.01, and the negative prediction value was 0.99 Table 2 The ep during surgery monitored false positive patient data Table 3 Ep scans false negative patient data during surgery the authors believe that the mechanism of EP monitoring in surgery is that the deep structure of direct stimulation of the motor pathway slower under the cortex may bypass ischemic lesions and have false negative results; False positives monitored by EP are usually caused by changes in the gap between the cerebral cortex and the cranial cap, such as excessive brain displacement of cerebrospinal fluid Therefore, changes in epS cannot be determined true or false, and once a wrong decision is made, the patient can have harmful results It is recommended to use MVD ultrasound, ICG video angiography, etc to make comprehensive judgment, so as not to have adverse consequences the final author points out that EP monitoring is an effective means to detect cerebral ischemic complications in aneurysm surgery Intraoperative EP monitoring has high specificity and negative predictors, but false positive and false negative results remain Therefore, it is important to design an EP monitoring program in aneurysm clamping that may occur with ischemic neurodysfunction (The first affiliated hospital of Xinxiang Medical College
Li Fuguang compiled, Liu Chonghong, of the First People's Hospital of Changshu City, Jiangsu Province, review, the editor-in-chief of "Outside the God Information" and the Professor Chen Chengcheng , affiliated with Fudan University), the relevant links