Abstract
Posterior tibial nerve somatosensory evoked potentials (SEPs) were monitored intraoperatively in 22 patients with anterior communicating artery (Acom) aneurysms and 3 patients with distal anterior cerebral artery (ACA) aneurysms. Changes in peak latency and amplitude of the early cortical potentials of SEPs were evaluated. In 14 cases without temporary occlusion, the SEPs did not change during the surgical course. In 11 patients with temporary occlusion of A1 segment for Acom aneursms, lasting from 3 to 44 minutes, 10 demonstrated variable changes of P37-N46 interpeak amplitude. In 1 case, SEP signals remained stable. The P37 and N46 peak latency were not prolonged more than 2 msec in all cases. Significant SEP changes (a decrease in P37-N46 amplitude more than 50% to baseline value) were found in 4 cases. In these cases, the temporary occlusion was used intermittently, and the occlusion time did not go over 10 minutes per occlusion. In 3 cases, the wave form of SEP recoved to the baseline after the release of temporary occlusion. However, 1 case where the SEP did not fully recover suffered from transient motor paresis of a unilateral lower extremity. Despite the large variability of territories of ACA, intraoperative posterior tibial nerve SEP monitoring was helpful in the operative management such as temporary vessel occlusion.
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