Reversible Change in Somatosensory Evoked Potential – Looks trustworthy

Abstract

Temporary clip placement on parent vessel is a commonly used technique in cerebrovascular surgery to facilitate clipping of intracranial aneurysms. However, it increases the risk of decreased distal cerebral perfusion. Therefore, prolonged clip time can lead to new onset stroke. Somatosensory evoked potentials (SSEPs) can be used during aneurysm clipping to detect changes in cerebral blood ?ow with surgical manipulation. Evidence has shown that irreversible SSEP loss and delayed restoration of blood ?ow after SSEP loss leads to postoperative neurologic de?cits. In this case report, we present a case of subarachnoid haemorrhage due to right middle cerebral artery aneurysm presenting for clipping, where patient developed significant loss of SSEP intraoperatively in spite of burst suppression due to prolonged TC time. However, early removal of clip and restoration of blood flow reverted the SSEP changes and prevented stroke. Although, SSEP monitoring alone can have its own limitations, we would still emphasize on its importance through this case.

Key words: Somatosensory evoked potentials; aneurysm clipping; stroke; temporary clip