Abstract:

Objective To evaluate the application of intraoperative somatosensory evoked potential (SEP）combined with microvascular Doppler sonography (MDS) in intracranial aneurysm clipping surgery. Methods Fifty-three patients with a total of 57 intracranial aneurysms undergoing intraoperative intracranial aneurysm clipping surgery were evaluated with intraoperative SEP and MDS, and the clips were repositioned according to the findings of MDS and SEP. Patients were reexamined with digital subtraction angiography (DSA) after operation,and were evaluated with Glasgow outcome scale (GOS) one month after operation. Results There was no persistent change of SEP in all patients during surgical procedure.Aneurysms were distinguished from parent arteries in 9 (17．0％) patients by MDS. Persistent blood flow through the aneurysmal sac was revealed in 3 (5.3％) aneurysms after clipping, and the clips were repositioned. Parent artery stenosis after clipping was indicated by MDS in 6 (11.3%) cases, and the clips were repositioned. DSA revealed that there was no aneurysmal residue and stenosis of parent and adjacent vessels in 50 patients, which was in line with the findings by SEP and MDS during operation. Patients were followed up 1 month after operation, two patients died, and the other patients had 5 points (41 patients), 4 points (8 patients), 3 points (1 patient) and 2 points (1 patient) of GOS respectively. Conclusion Application of intraoperative SEP combined with MDS is a noninvasive, convenient and effective technique in intracranial aneurysm clipping surgery, which may help to improve the surgical outcomes.

Key words: somatosensory evoked potential, microvascular Doppler sonography, intraoperative monitoring, aneurysm, clipping