Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery

Abstract

Object. The lack of a specified intraoperative method for monitoring anterior choroidal artery (AChA) blood flow insufficiency (BFI) led the authors to devise a method for checking the BFI in this artery during aneurysm surgery. To this end, the authors relied on the intraoperative motor evoked potentials (MEPs) elicited by electrical stimulation of the hand motor cortex. Methods. The study population consisted of 108 patients with internal carotid artery (ICA) aneurysms who underwent surgery via a standard frontotemporal craniotomy. After the dura mater had been opened, a grid electrode strip with 16 small electrodes was inserted subdurally into the hand motor cortex from the edge of the craniotomy. To check BFI in the AChA, the hand motor cortex was stimulated at an intensity level between 10 and 18 mA. The MEPs were successfully recorded from the contralateral thenar muscles in all 108 patients. There was no postoperative motor paresis in 88 patients in whom the MEPs remained unchanged during the performance of various surgical maneuvers. Among the other 20 patients, 19 manifested transient MEP changes, but 15 of those patients experienced no postoperative motor paresis. In four patients who exhibited transient MEP changes, either after aneurysm clipping or during temporary occlusion of the ICA and/or AChA, hemiparesis occurred postoperatively but disappeared within 24 hours. In one patient with an ICA—posterior communicating artery aneurysm, the MEP disappeared and did not reappear by the time of dural closure. Severe hemiplegia developed in this patient and a computerized tomography scan obtained postoperatively revealed a new low-density area in the internal capsule. Conclusions. The findings of this study suggest that the monitoring method that is introduced here is safe and reliable for detecting intraoperative BFI in the AChA.