Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 10:8:79.
doi: 10.4103/sni.sni_410_16. eCollection 2017.

Safe time duration for temporary middle cerebral artery occlusion in aneurysm surgery based on motor-evoked potential monitoring

Jun Tanabe  1 , Tatsuya Ishikawa  1 , Junta Moroi  1
Affiliations

Safe time duration for temporary middle cerebral artery occlusion in aneurysm surgery based on motor-evoked potential monitoring

Jun Tanabe et al. Surg Neurol Int. .

Abstract

Background: Temporary vessel occlusion of the parent artery is an essential technique for aneurysm surgery. Our aim was to clarify the safe time for temporary occlusion for aneurysm surgery, that is the "safe time duration" (STD), in which brain tissue exposed to ischemia will almost never fall into even the ischemic penumbra during temporary occlusion of the middle cerebral artery (MCA), and even transient postoperative motor impairment will be rare using intraoperative motor-evoked potentials (MEP).

Methods: Twenty-four patients underwent MCA aneurysm clipping surgery with MEP monitoring for 13 ruptured aneurysms and 11 unruptured aneurysms. The duration of vessel occlusion in patients without MEP changes was measured as the STD. Average STD was calculated as 95% confidence interval for the population mean using sample data from patients with MEP changes and patients without changes.

Results: All 24 patients received proximal flow control only. Five patients (20.8%) developed significant intraoperative MEP changes. Time to MEP change (i.e., STD) in these patients was 4.6 ± 2.1 min. In patients without MEP changes, STD was 2.7 ± 1.4 min. Average STD was thus 3.1 ± 0.7 min.

Conclusions: The 95% lower confidence limit for average STD was 2.4 min when applying temporary occlusion on the proximal side of the MCA. This STD resembled that previously reported for temporary proximal occlusion of the internal carotid artery.

Keywords: Aneurysm surgery; middle cerebral artery; motor-evoked potential; temporary vessel occlusion.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Histogram of safe time duration (STD) for temporary vessel occlusion. The shaded column demonstrates average STD, representing the 95% confidence interval for the population mean calculated from sample data in patients with motor-evoked potential (MEP) changes and in patients without changes. ★: MEP changes. Receiver-operating characteristic analysis for detecting MEP changes
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Abdulrauf SI, Vuong P, Patel R, Sampath R, Ashour AM, Germany LM, et al. “Awake” clipping of cerebral aneurysms: Report of initial series. J Neurosurg. 2016 [Epub ahead of print] - PubMed
    1. Guo L, Gelb AW. The use of motor evoked potential monitoring during cerebral aneurysm surgery to predict pure motor deficits due to subcortical ischemia. Clin Neurophysiol. 2011;122:648–55. - PubMed
    1. Horiuchi K, Suzuki K, Sasaki T, Matsumoto M, Sakuma J, Konno Y, et al. Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms. J Neurosurg. 2005;103:275–83. - PubMed
    1. Ishikawa T. What is the role of clipping surgery for ruptured cerebral aneurysms in the endovascular era? A review of recent technical advances and problems to be solved. Neurol Med Chir (Tokyo) 2010;50:800–8. - PubMed
    1. Lavine SD, Masri LS, Levy ML, Giannotta SL. Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery: Time limitation and advantage of brain protection. J Neurosurg. 1997;87:817–24. - PubMed

LinkOut - more resources