Anterior Choroidal Artery Infarction with No Abnormalities of Motor Evoked Potentials During Cerebral Aneurysm Surgery -A Case Report-

Case Report

J Korean Assoc EMG Electrodiagn Med 2017;19(2):76-82.
Published online December 31, 2017.

Received: 19 September 2017 • Revised: 19 October 2017 • Accepted: 22 October 2017

Abstract

Motor evoked potentials (MEPs) with somatosensory evoked potentials (SSEPs) have been used to prevent neurological complication during cerebral aneurysm surgery. This case shows postoperative anterior choroidal artery (AChA) infarction with decreased SSEPs, in spite of preserved MEPs during aneurysm clipping. A 58-year-old man with ruptured aneurysm between right internal carotid artery and AChA received aneurysm clipping. During temporal arterial clipping, left tibial SSEPs amplitude decreased by 95% and median SSEPs decreased by 89% of the baseline. SSEPs changes lasted for 10 minutes and there was no change of MEPs. After operation, mental state changed to drowsy and left side weakness occurred. Cerebral angiography showed non-visualized right AChA and brain MRI showed right AChA infarction. MEPs are difficult to be performed continuously because patient movement may interfere with microsurgery and raise safety concerns. We suppose that SSEPs are possibly complement of MEPs to take consider the subcortical perfusion such as AChA.

Key Words: intraoperative neurophysiological monitoring, cerebral aneurysm, anterior choroid infarction