Abstract
Background: We investigated evoked potential (EP) changes during superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery and their correlations with imaging and clinical findings postoperatively. Methods: This retrospective study included patients who underwent STA-MCA bypass surgery due to ischemic stroke with large artery occlusion (MB group). Patients who underwent unruptured MCA aneurysm clipping were enrolled in the control group (MC group). Median and tibial somatosensory evoked potentials (SSEP), and motor evoked potentials recorded from the abductor pollicis brevis (APB-MEP) and abductor hallucis (AH-MEP) were measured intraoperatively. Modified Rankin scale (mRS) and perfusion-weighted imaging (PWI) related variables, i.e., mean transit time (MTT) and time to peak (TTP), were assessed. Results: Δmedian SSEP, ΔAPB-MEP, and ΔAH-MEP were significantly higher in the MB group than in the MC group (p = 0.027, p = 0.006, and p = 0.015, respectively). APB-MEP and AH-MEP amplitudes were significantly increased at the final measurement (p = 0.010 and p < 0.001, respectively). The ΔTTP asymmetry index was moderately correlated with ΔAPB-MEP (r = 0.573, p = 0.005) and ΔAH-MEP (r = 0.617, p = 0.002). ΔAPB-MEP was moderately correlated with ΔMTT (r = 0.429, p = 0.047) and ΔmRS at 1 month (r = 0.514, p = 0.015). Conclusions: MEP improvement during STA-MCA bypass surgery was partially correlated with PWI and mRS and could reflect the recovery in cerebral perfusion.
Highlights
Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a surgical treatment that involves extracranial to intracranial revascularization [1]
This study aimed to confirm whether evoked potential (EP) measured by Intraoperative neurophysiological monitoring (IONM) during superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery could significantly be improved after vascular anastomosis
As for vascular risk factors, hypertension and diabetes were observed in 86.4% and 54.4% of patients in the MB group, respectively, significantly higher than that observed in the MC group (51.9% and 11.0%; p = 0.005 and p < 0.001, respectively)
Summary
Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a surgical treatment that involves extracranial to intracranial revascularization [1]. It is mainly performed for diseases such as ischemic stroke secondary to moyamoya disease, intracranial giant aneurysm, and intracranial tumor resection requiring vessel sacrifice [2,3,4]. The representative methods of directly evaluating vascular patency during STA-MCA bypass surgery are microvascular Doppler ultrasonography and indocyanine green angiography [6,7]. We investigated evoked potential (EP) changes during superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery and their correlations with imaging and clinical findings postoperatively. Conclusions: MEP improvement during STA-MCA bypass surgery was partially correlated with PWI and mRS and could reflect the recovery in cerebral perfusion
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