Sensibilité, spécificité et impact sur la stratégie chirurgicale du neuromonitorage peropératoire par potentiels évoqués somesthésiques en chirurgie vasculaire pratiquée avec arrêt circulatoire sous hypothermie profonde.

Ghariani, S.;Spaey, J;Liard, L;Verhelst, Robert;Guerit, Jean-Michel;et.al.
(1998) Neurophysiologie Clinique — Vol. 28, n° 4, p. 335-341 (1998)

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Authors
  • Ghariani, S.
    Author
  • Spaey, J
    Author
  • Liard, L
    Author
  • Verhelst, RobertUCLouvain
    Author
  • El Khoury, GebrineUCLouvain
    Author
  • Noirhomme, PhilippeUCLouvain
    Author
  • Matta, AmineUCLouvain
    Author
  • Guerit, Jean-MichelUCLouvain
    Author
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Abstract
AIM: Median nerve somatosensory evoked potentials (SEP) monitoring performed in deep hypothermic circulatory arrest is useful in determining when brain cooling may sufficiently permit circulatory arrest, and to immediately indicate when brain injury occurs. The aim of this retrospective study, including 58 patients, is to determine SEP sensitivity, specificity and impact on the surgical strategy. METHOD: Sensitivity was determined on patients presenting new neurological complications. Specificity was measured on the patients without any new neurological defect. The impact of intraoperative SEP on the surgical strategy was determined when the occurrence of SEP alterations had provoked a modification of the surgical procedure. RESULTS: Five patients died intraoperatively due to non-neurological complications. Fourteen patients presented new neurological complications. SEP sensitivity reaches 64.3% when all the complications are included, but increases to 100% in our series if late postoperative complications, paraplegia and tibial posterior nerve lesion are excluded because median nerve SEP are not able to detect such complications. SEP monitoring was uneventful in the 39 patients whose did not present neurological complication: thus SEP specificity is absolute in our series. SEP had an impact on the surgical procedure whenever neurological complications due to hemodynamic disturbances occurred. CONCLUSION: This retrospective study shows the interest of intraoperative SEP as an useful tool for promptly identifying and preventing the neurological complication of hypothermic circulatory arrest.
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Ghariani, S., Spaey, J., Liard, L., Verhelst, R., El Khoury, G., Noirhomme, P., d’Udekem, Y., Matta, A., Dion, R., & Guerit, J.-M. (1998). Sensibilité, spécificité et impact sur la stratégie chirurgicale du neuromonitorage peropératoire par potentiels évoqués somesthésiques en chirurgie vasculaire pratiquée avec arrêt circulatoire sous hypothermie profonde. Neurophysiologie Clinique, 28(4), 335-341. https://doi.org/10.1016/S0987-7053(98)80004-X (Original work published 1998)