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Aneurysm Clipping

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Parthasarathy D Thirumala – One of the best experts on this subject based on the ideXlab platform.

  • diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Jeffrey R Balzer, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala

    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p < 0.001, McNemar’s test), but not sensitivity (48% vs. 42%, p = 0.621, McNemar’s test) of SSEPs for perioperative stroke. A stepwise logistic regression model selected SSEP amplitude loss (p = 0.006, OR = 3.7 [95% CI 1.5–9.2]) and the SSEP change duration (p = 0.034, OR = 1.8 [95% CI 1.1–3.1]) as independent predictors of perioperative stroke. SSEP changes induced by temporary Clipping were highly reversible compared to other SSEP changes (94% vs. 60%, p = 0.003, Fisher exact test), and typically responded to clip removal or readjustment. SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral Aneurysm surgery.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala

    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • diagnostic value of somatosensory evoked potential monitoring during cerebral Aneurysm Clipping a systematic review
    World Neurosurgery, 2016
    Co-Authors: Parthasarathy D Thirumala, Reshmi Udesh, Aditya Muralidharan, Karthy Thiagarajan, Donald J Crammond, Yuefang Chang, Jeffrey Balzer

    Abstract:

    Background Perioperative stroke is a known complication in patients undergoing surgical Clipping of cerebral Aneurysms. Objective To evaluate whether intraoperative changes in somatosensory-evoked potential (SSEP) monitoring during cerebral Aneurysm Clipping is diagnostic of perioperative stroke. Methods An electronic search of PubMed, Embase, and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral Aneurysm Clipping for predicting postoperative outcomes. All titles and abstracts were screened independently on the basis of predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial Aneurysms who underwent surgical Clipping with intra-operative SSEP monitoring and postoperative neurologic assessment; studies published in English on adult humans ≥18 years with sample size of ≥50; and studies inclusive of an abstract with adequate details on outcomes. Results A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95% confidence interval [95% CI] −76.3 to 90.3) but weaker sensitivity of 56.8% (95% CI 44.1−68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI 5.133−11.767) suggested that the odds of observing an SSEP change among those with a postoperative neurologic deficit were 7 times greater than those without a neurologic deficit. Conclusion Intraoperative SSEP monitoring is highly specific for predicting neurologic outcome after cerebral Aneurysm Clipping. Patients with postoperative neurologic deficits are 7 times more likely to have had intraoperative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates after cerebral Aneurysm Clipping.

Donald J Crammond – One of the best experts on this subject based on the ideXlab platform.

  • diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2020
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Jeffrey R Balzer, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala

    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p < 0.001, McNemar’s test), but not sensitivity (48% vs. 42%, p = 0.621, McNemar’s test) of SSEPs for perioperative stroke. A stepwise logistic regression model selected SSEP amplitude loss (p = 0.006, OR = 3.7 [95% CI 1.5–9.2]) and the SSEP change duration (p = 0.034, OR = 1.8 [95% CI 1.1–3.1]) as independent predictors of perioperative stroke. SSEP changes induced by temporary Clipping were highly reversible compared to other SSEP changes (94% vs. 60%, p = 0.003, Fisher exact test), and typically responded to clip removal or readjustment. SSEP changes have high specificity and modest sensitivity for perioperative stroke. Stroke risk is a function of both the magnitude of SSEP amplitude loss and the duration of its loss. Given the modest sensitivity, patients may benefit from multimodal monitoring including motor-evoked potentials during cerebral Aneurysm surgery.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala

    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • perioperative stroke after cerebral Aneurysm Clipping risk factors and postoperative impact
    Journal of Clinical Neuroscience, 2017
    Co-Authors: Ahmed Kashkoush, Donald J Crammond, Yuefang Chang, Brian T Jankowitz, Chris Nguyen, Paul A Gardner, Daniel A Wecht, Robert M Friedlander, Miguel Habeych, Jeffrey R Balzer

    Abstract:

    Abstract Stroke is a devastating complication after intracranial Aneurysm Clipping. Understanding the risk factors that prognosticate perioperative stroke may help to identify patients that would benefit from neuroprotective therapy. This study assesses patient-specific independent predictors of perioperative stroke in relation to surgical Aneurysm Clipping. Additionally, this study evaluates the postoperative complications of stroke. We performed a retrospective chart review of 437 patients with ruptured and unruptured intracranial Aneurysms, which underwent surgical Clipping from 2006 to 2013. Multivariate logistical regression was utilized to assess the effect of age, race, gender, subarachnoid hemorrhage, Hunt and Hess (H/H) grade, Aneurysm location, and intraoperative somatosensory evoked potentials (SSEPs) changes on the frequency of perioperative stroke. Thirty-five (8.0%) patients developed a stroke within 24 h postoperatively. Patients with significant intraoperative SSEP changes were 7.33 (95% confidence interval [CI]: 3.51–15.31) times more likely to develop perioperative strokes. In patients who presented with H/H grade 5, the odds ratio for developing perioperative stroke was 9.21 (95% CI: 1.28–66.13) respectively. In the absence of Aneurysm rupture, patients presenting with new-onset stroke were more likely to suffer postoperative complications, stay in the intensive care unit longer, and be discharged to in-patient rehabilitation compared to patients without new-onset stroke. This study suggests that severity of subarachnoid hemorrhage based on the patient’s clinical condition increases the risk of perioperative stroke in patients with surgical Aneurysm Clipping. SSEP changes and high-grade H/H scores can serve as independent predictors of perioperative stroke, with the latter having the greatest predictive value.

Jeffrey Balzer – One of the best experts on this subject based on the ideXlab platform.

  • Diagnostic accuracy of somatosensory evoked potentials during intracranial Aneurysm Clipping for perioperative stroke
    Journal of Clinical Monitoring and Computing, 2019
    Co-Authors: Ahmed Kashkoush, Jeffrey Balzer, Donald J Crammond, Miguel Habeych, Christopher Nguyen, Parthasarathy D Thirumala

    Abstract:

    Somatosensory evoked potentials (SSEPs) are utilized during Aneurysm Clipping to detect intraoperative ischemia. We assess the diagnostic accuracy of SSEPs in predicting perioperative stroke during Aneurysm Clipping. A retrospective review was conducted of 429 consecutive patients who underwent surgical Clipping for ruptured and unruptured cerebral Aneurysms with intraoperative SSEP monitoring from 2006 to 2013. The relationship between perioperative stroke and SSEP changes was analyzed by calculating the sensitivity, specificity, and area under a Receiving Operating Characteristic curve. Sensitivity and specificity were 42% and 90%, respectively. Area under the curve was 0.66 (95% confidence interval, 0.53–0.79). Reclassification of reversible temporary clip changes to correct for paradoxical classification of SSEP false positives raised the sensitivity from 42 to 65% (p = 0.041, Chi squared test). EEG (electroencephalography) changes increased the specificity (98% vs. 90%, p 

  • diagnostic value of somatosensory evoked potential monitoring during cerebral Aneurysm Clipping a systematic review
    World Neurosurgery, 2016
    Co-Authors: Parthasarathy D Thirumala, Reshmi Udesh, Aditya Muralidharan, Karthy Thiagarajan, Donald J Crammond, Yuefang Chang, Jeffrey Balzer

    Abstract:

    Background Perioperative stroke is a known complication in patients undergoing surgical Clipping of cerebral Aneurysms. Objective To evaluate whether intraoperative changes in somatosensory-evoked potential (SSEP) monitoring during cerebral Aneurysm Clipping is diagnostic of perioperative stroke. Methods An electronic search of PubMed, Embase, and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral Aneurysm Clipping for predicting postoperative outcomes. All titles and abstracts were screened independently on the basis of predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial Aneurysms who underwent surgical Clipping with intra-operative SSEP monitoring and postoperative neurologic assessment; studies published in English on adult humans ≥18 years with sample size of ≥50; and studies inclusive of an abstract with adequate details on outcomes. Results A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95% confidence interval [95% CI] −76.3 to 90.3) but weaker sensitivity of 56.8% (95% CI 44.1−68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI 5.133−11.767) suggested that the odds of observing an SSEP change among those with a postoperative neurologic deficit were 7 times greater than those without a neurologic deficit. Conclusion Intraoperative SSEP monitoring is highly specific for predicting neurologic outcome after cerebral Aneurysm Clipping. Patients with postoperative neurologic deficits are 7 times more likely to have had intraoperative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates after cerebral Aneurysm Clipping.