Multimodal Monitoring Strategy Is Decisive in Elective Middle Cerebral Artery Aneurysm Clipping: A Case Report.

Abstract

BACKGROUND:

The intraoperative use of neurophysiological monitoring (IONM) and indocyanine green video angiography (ICGVA) for aneurysm clipping have evolved during the last years. Both modalities are useful and safe by allowing greater rates of complete aneurysm occlusion with less intraoperative complications and postoperative neurologic deficits. We report a case of attempted aneurysm clipping in which the combined use of ICGVA and IONM was crucial for intraoperative decision-making.

CASE DESCRIPTION:

A 62-year-old woman was operated for an incidental 6-mm aneurysm at the origin of the right fronto-opercular branch. During aneurysm clipping, IONM amplitudes dropped drastically, despite patency of the parent artery and perforators in ICGVA. Several attempts for clipping were made with recurring drops in IONM amplitudes, which forced us to leave the aneurysm untreated. The patient had a postoperative left-sided hemiparesis that improved on follow-up. Thereafter, the aneurysm was treated with stent-assisted coiling.

CONCLUSIONS:

The combination of IONM and ICGVA during aneurysm surgery allows for a better assessment of vascular integrity and patient's postoperative outcome than ICGVA alone. Simultaneous evaluation of vessel patency and integrity of the somatosensory and motor pathways illustrates the complementarity of testing different modalities for intraoperative decision-making and for maximizing safeness in aneurysm clipping.

• Authors: Sandra Fernandes Dias, Elisabeth Jehli, Luca Regli, Johannes Sarnthein, Menno R Germans
• Journal: World neurosurgery (World Neurosurg) Vol. 122 Pg. 43-47 (02 2019) ISSN: 1878-8769 [Electronic] United States
• PMID: 31108065 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Coloring Agents
• Indocyanine Green

Topics

• Cerebral Angiography (methods)
• Coloring Agents
• Elective Surgical Procedures (methods)
• Female
• Humans
• Indocyanine Green
• Intracranial Aneurysm (diagnostic imaging, surgery)
• Intraoperative Neurophysiological Monitoring (methods)
• Middle Aged
• Stents
• Treatment Outcome
• Video-Assisted Surgery (methods)