수술중신경계 감시를 시행한 뇌동맥류 결찰술이후 발생한 전맥락막동맥 경색증 1예

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.