The incidence of unacceptable movement with motor evoked potentials during craniotomy for aneurysm clipping.

Journal Article (Journal Article)

OBJECTIVE: To review the experience at a single institution with motor evoked potential (MEP) monitoring during intracranial aneurysm surgery to determine the incidence of unacceptable movement. METHODS: Neurophysiology event logs and anesthetic records from 220 craniotomies for aneurysm clipping were reviewed for unacceptable patient movement or reason for cessation of MEPs. Muscle relaxants were not given after intubation. Transcranial MEPs were recorded from bilateral abductor hallucis and abductor pollicis muscles. MEP stimulus intensity was increased up to 500 V until evoked potential responses were detectable. RESULTS: Out of 220 patients, 7 (3.2%) exhibited unacceptable movement with MEP stimulation-2 had nociception-induced movement and 5 had excessive field movement. In all but one case, MEP monitoring could be resumed, yielding a 99.5% monitoring rate. CONCLUSIONS: With the anesthetic and monitoring regimen, the authors were able to record MEPs of the upper and lower extremities in all patients and found only 3.2% demonstrated unacceptable movement. With a suitable anesthetic technique, MEP monitoring in the upper and lower extremities appears to be feasible in most patients and should not be withheld because of concern for movement during neurovascular surgery.

Full Text

Duke Authors

Cited Authors

  • Hemmer, LB; Zeeni, C; Bebawy, JF; Bendok, BR; Cotton, MA; Shah, NB; Gupta, DK; Koht, A

Published Date

  • January 2014

Published In

Volume / Issue

  • 81 / 1

Start / End Page

  • 99 - 104

PubMed ID

  • 23043993

Electronic International Standard Serial Number (EISSN)

  • 1878-8769

Digital Object Identifier (DOI)

  • 10.1016/j.wneu.2012.05.034


  • eng

Conference Location

  • United States