The Efficacy of Motor-evoked Potentials on Cerebral Aneurysm Surgery and New-onset Postoperative Motor Deficits

Surgical clipping may cause stenosis of parent arteries or occlusion of perforating arteries in cerebral aneurysm surgery. To prevent postoperative motor deficits, motor-evoked potentials (MEPs) have been used. This enables to detect cerebral ischemia. However, the rate of false negatives (motor deficits with preserved MEP) has been relatively higher than in aortic surgery. We hypothesized that postoperative motor deficits with preserved intraoperative MEP do not always represent false negatives. We reviewed medical records of patients for cerebral aneurysms surgery with transcranial MEP monitoring from September 2003 to March 2009. We reviewed aneurysm location and size, abnormal computed tomography findings, and clinical outcome. Motor status was evaluated immediately after extubation and anytime when the symptom of motor deficits was found. One hundred and eleven patients underwent cerebral aneurysm clipping with transcranial MEP. Ninety-eight patients manifested no intraoperative MEP changes and no postoperative motor deficits. Six patients showed intraoperative MEP changes, resulting in no motor deficits in 4 patients with MEP recovery and hemiparesis in 2 without MEP recovery. Four patients of 6 had aneurysm in anterior choroidal artery (AchA). Other 6 patients showed postoperative motor deficits despite preserved intraoperative MEP. Two of 6 patients showed no motor deficits just after extubation, but developed deficits 5 hours after coming out of anesthesia. Only 1 of the 6 patients had aneurysm in AchA. In AchA aneurysm surgery, intraoperative MEP monitoring seems to be useful. False negative in MEP monitoring may include new-onset hemiparesis despite preserved intraoperative MEP.