Diagnostic Accuracy of Somatosensory Evoked Potentials and Electroencephalography During Endovascular Treatment of Unruptured Cerebral Aneurysms

Abstract

Endovascular treatment (EVT) of unruptured cerebral aneurysms (UCA) offers a safer alternative to clipping. However, it is still associated with an increased risk for Post Procedural Neurological Deficits (PPND). Prompt recognition using intraoperative neurophysiologic monitoring (IONM) and intervention can reduce the incidence and impact of new post-operative neurological complications. We aim to evaluate the diagnostic accuracy of IONM in predicting PPND after EVT of UCA. We included 414 patients who underwent EVT for UCA from 2014 to 2019. The sensitivities, specificities, and diagnostic odds ratio of SSEP and EEG monitoring methods were calculated. We also determined their diagnostic accuracy using receiver operating characteristic (ROC) plots. The highest sensitivity of 67.7% (95% CI, 34.9-90.1%) was obtained when either modality had a change. Simultaneous changes in both modalities have the highest specificity of 97.8% (95% CI, 95.8-99.0%). The area under the ROC curve was 0.795 (95% CI, 0.655-0.935) for changes in either modality. IONM with SSEP alone or in combination with EEG has high diagnostic accuracy in detecting periprocedural complications and resultant PPND during EVT of UCA. IONM allows for confident and early intervention when obvious complications may not be evident to the endovascular professional.