Identifying Perfusion Changes With SSEP in Aneurysm Clipping Surgery
By Admin | April 01, 2023
Few things strike fear into people’s hearts the way the dreaded aneurysm can. Cerebral aneurysms occur when a weak area in the wall of an artery in the brain balloons out, creating potential for rupture and significant hemorrhaging. This is where aneurysms’ notorious reputation begins.
With a consequence list that includes brain damage, stroke, and death, their perceived danger is only intensified with the knowledge that most brain aneurysms aren’t detected until they rupture. And according to Penn Medicine, “about 25% of patients don’t survive the first 24 hours after a brain aneurysm, and another 25% die from complications in the first 6 months of recovery.”
In other cases, like that of one 61-year-old female, cerebral aneurysms are detected before they rupture. Still, even when an aneurysm is determined to be a good candidate for surgical removal, the procedure still carries some risk including possible damage to other blood vessels, the potential for aneurysm recurrence and rebleeding, and a risk of stroke.
One of the most effective surgical options available is microvascular clipping. During an aneurysm clipping surgery, the surgeon cuts off blood flow to the aneurysm by placing a clip on the ‘neck’ of the aneurysm, causing it to gradually shrink. While clipping procedures require open brain surgery, aneurysms that are completely clipped generally, do not recur, making them an enticing option when the location, size, and shape of the aneurysm allows for the procedure.
During this 61-year-old’s procedure, somatosensory evoked potentials (SSEP) and electroencephalography were used to monitor the integrity of sensory pathways and the patient’s cerebral perfusion. This is particularly important because changes in the brain’s blood pressure during clipping can have significant impacts on the surgical outcome.
After changes in the SSEP signals alerted the surgeon to the presence of a plaque in the patient’s artery, the patient was closed and transported to the IR unit where the plaque could be removed immediately.
Without SSEP monitoring, the surgeon may not have identified the plaque. The result could have caused a stroke by blocking blood flow in the brain, but thankfully was avoided.
Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring (IONM). For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit https://www.axisneuromonitoring.com.
