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KMID : 0361419950190010171
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Journal of Korean Academy of Rehabilitation Medicine
1995 Volume.19 No. 1 p.171 ~ p.178
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Two Cases of Somatosensory Evoked Potential Monitorings during Aneurysm Surgeries
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고영진
강세윤/김은경/최은석/조은진
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Abstract
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Somatosensory evoked potential(SEP) have characteristics which are of value in intraoperative monitoring in situations where the brain is at risk from ischemia. The median nerve SEP provides the information from median nerve innervated dermatome
to
the
part of the sensory cerebral cortex representing the distribution of the median nerve (the hand) which is supplied by the middle cerebral artery.
Intraoperative SEP monitoring of median nerve was carried out in two aneurysm cases of middle cerebral artery where temporary occlusion of the internal carotid artery was employed selectively. Base line SEPs were obtained shortly after the
inducted
of
general anesthesia and were recoreded continuously throughout operation. Their absolute latencies and amplitudes were subsequently determined. Delay or disappearance of the N20 potential following occlusion is regarded as a 'danger' signal. We
consider
that these phenomena possibly result in infarction in the territory of the clipped cerebral artery. The following two cases were undertaken to elucidate more carefully the utility of SEP monitoring in order to reduce such morbidity. In the first
case,
the surgeon was alerted by decreased amplitude of the evoked potentials followed by the artery was released and the evoked potential returned. There was no new focal neuroligical deficit postoperatively. While in the second case, transient new
deficits
were seen due to prolonged clipping.
Delay or disappearance of the SEP should therefore be capable of giving an early warning of regional ischemia and that there should be a "window of therapeutic opportunity" in which effective remedial measured can be taken in order to avoid
permanent
neurological damage.
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KEYWORD
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