Abstract

IntroductionThe present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function.MethodsThis study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed.ResultsTreated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case.ConclusionAlthough significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.

Highlights

  • The present study aimed to determine the incidence of intraprocedural visual evoked potential (VEP) and motor evoked potential (MEP) changes and whether such changes correlate with intraprocedural complications among patients after endovascular treatment of intracranial aneurysms

  • Aneurysms treated under VEP monitoring were predominantly located in the internal carotid artery (ICA) (95%), with the remaining located in the posterior cerebral artery (PCA)

  • Stent-assisted coil embolization was applied to 77% and a flow diverter stent was applied to 16% of patients

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Summary

Introduction

The present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function. Ischemic complications including visual disturbance are a major form of morbidity with endovascular intracranial aneurysm treatment. Recent studies have suggested that SSEP and MEP monitoring can reliably evaluate the ischemic status during endovascular aneurysm treatment and can improve clinical outcomes [9–12]. The possible utility of intraoperative visual evoked potential (VEP) monitoring has been reported for parasellar tumors and aneurysm surgery [13–16]. The present study aimed to determine the incidence of intraprocedural VEP and MEP changes and whether such changes correlate with intraprocedural complications among patients after endovascular treatment of intracranial aneurysms

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