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. 2025 Jan 9:38:100549.
doi: 10.1016/j.ensci.2025.100549. eCollection 2025 Mar.

Intraoperative neuromonitoring as an independent predictor for postoperative delirium in ICU following aneurysm clipping

Abdullah M Al-Qudah  1   2 , Pooja S Tallapaneni  3 , Donald J Crammond  1 , Jeffrey Balzer  1 , Katherine M Anetakis  1 , Varun Shandal  1 , Jingyuan Biaesch  3 , Malik Ghannam  4 , Neelesh Nadkarni  3 , Bradley A Gross  5 , Michael Lang  5 , Kathirvel Subramanium  3 , Senthilkumar Sadhasivam  3 , Parthasarathy D Thirumala  1
Affiliations

Intraoperative neuromonitoring as an independent predictor for postoperative delirium in ICU following aneurysm clipping

Abdullah M Al-Qudah et al. eNeurologicalSci. .

Abstract

Objectives: This study aims to evaluate the diagnostic accuracy of significant intraoperative neurophysiological monitoring (IONM) changes as an independent predictor of postoperative delirium (POD) in patients undergoing aneurysm clipping.

Methods: IONM and clinical data from 273 patients who underwent craniotomy for aneurysm clipping from 2019 until 2021 were retrospectively reviewed. Significant IONM changes and POD were respectively evaluated based on visual review of data and clinical documentation. POD was assessed multiple times in the ICU using the Intensive Care Delirium Screening Checklist (ICDSC).

Results: Of the 273 patients undergoing craniotomy with IONM, 83 had POD (30.4 %). Significant IONM changes were noted in 42 patients, of which 19 patients had POD (45.2 %). In contrast, 231 patients had no IONM changes during surgery, of which 64 (27.7 %) patients had POD. Multivariable analysis showed that significant IONM changes were associated with POD, OR: 2.09 (95 % CI 1.01-4.43, p-value: 0.046). Additionally, somatosensory evoked potentials (SSEP) changes were significantly associated with POD (p-value: 0.044).

Conclusion: Significant IONM changes are associated with an increased risk of POD in patients undergoing craniotomy for aneurysm clipping. Our findings offer a strong basis for future research and analysis of EEG and SSEP monitoring to detect and possibly prevent POD.

Keywords: Aneurysm; Clipping; Craniotomy; Delirium; ICU; Intraoperative neurophysiologic monitoring; SSEP; ُEEG.

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Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors and none of the authors have potential conflicts of interest to be disclosed.

Figures

Fig. 1
Fig. 1
EEG of the same case in Fig. 2 A. Baseline before intervention. B. During, Burst suppression-flat EEG. C. After intervention, start of EEG return.
Fig. 2
Fig. 2
A. Cortical SSEP from left ulnar nerve. B. Significant decrease in cortical SSEP amplitude. C. Return of SSEP signal after intervention.
See this image and copyright information in PMC

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