Diagnostic Value of Somatosensory Evoked Potential Monitoring During Cerebral Aneurysm Clipping.

Diagnostic Value of Somatosensory Evoked Potential Monitoring During Cerebral Aneurysm Clipping.

World Neurosurg. 2015 Dec 17;

Authors: Thirumala PD, Udesh R, Muralidharan A, Thiagarajan K, Crammond DJ, Balzer JR, Chang YF

Abstract
BACKGROUND: Perioperative stroke is a known complication in patients undergoing surgical clipping of cerebral aneurysms.
OBJECTIVE: To evaluate whether intra-operative changes in somatosensory evoked potential (SSEP) monitoring during cerebral aneurysm clipping is diagnostic of perioperative stroke.
METHODS: An electronic search of PubMed, Embase and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral aneurysm clipping for predicting post-operative outcomes. All titles and abstracts were independently screened based on predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial aneurysms who underwent surgical clipping with intra-operative SSEP monitoring and postoperative neurological assessment; studies published in English on adult humans ≥ 18 years with sample size of ≥ 50; studies inclusive of an abstract with adequate details on outcomes.
RESULTS: A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95%CI-76.3-90.3) but weaker sensitivity of 56.8% (95%CI, 44.1-68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI, 5.133-11.767) suggested that the odds of observing an SSEP change among those with a post-operative neurological deficit were 7 times higher than those without a neurological deficit.
CONCLUSION: Intra-operative SSEP monitoring is highly specific for predicting neurological outcome following cerebral aneurysm clipping. Patients with post-operative neurological deficits are 7 times more likely to have had intra-operative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates following cerebral aneurysm clipping.

PMID: 26709156 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1mNuB3z
via IFTTT