Intraoperative Neurophysiological Monitoring in Ruptured-Unruptured Multiple Aneurysm Surgery: A Case Report
Abstract
Intraoperative Neurophysiological Monitoring (IONM) refers to the use of various electrophysiological methods to monitor the function of the brain, spinal cord, and related nerves during surgical procedures. IONM involves the use of neurophysiological recordings to detect changes in nervous system function during surgery, allowing doctors to identify potential nerve damage before it occurs. Reported is a 65-year-old male patient with a diagnosis of unruptured aneurysm of the Posterior Communicating Artery (PcomA) and left ophthalmic segment of C5 whose aneurysm was planned to be clipped. The patient was planned to have the aneurysm clipped under general anesthesia. The challenge in the anesthesia process for aneurysm cases is maintaining the pressure in the aneurysm and cerebral perfusion pressure (CPP), protecting the brain during periods of ischemia, and providing as wide an operating field as possible. Post-operatively, the patient showed stable neurological function with no new deficits, highlighting the importance of intraoperative neurophysiological monitoring in achieving a favorable outcome.
[2] Miró Lladó J, López-Ojeda P, Pedro J, Marnov A, Contreras L, Pariente L, et al. Evaluation of multimodal intraoperative neurophysiologic monitoring during supratentorial aneurysm surgery: a comparative study. Neurosurg Rev. 2022; 45(3):2161–73.
[3] Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative neuromonitoring in patients with intramedullary spinal cord tumor: a systematic review, meta-analysis, and case series. World Neurosurg. 2019; 125:498–510.
[4] Wing-hay HY, Chun-kwong EC. Introduction to intraoperative neurophysiological monitoring for anaesthetists. General Anaesthesia World Federation of Societies of Anestesiologist. 2019;1.
[5] Ban VS, Bhoja R, McDonagh DL. Multimodal analgesia for craniotomy. Curr Opin Anaesthesiol. 2019; 32(5):592–9.
[6] Elayat A, Jena SS, Nayak S, Sahu RN, Tripathy S. Enhanced recovery after surgery–ERAS in elective craniotomies-a non-randomized controlled trial. BMC neurology. 2021; 21:1–9.
[7] Batra A, Verma R, Bhatia VK, Chandra G, Bhushan S. Dexmedetomidine as an anesthetic adjuvant in intracranial surgery. Anesth Essays Res. 2017; 11(2):309–13.
[8] Tanskanen PE, Kyttä JV, Randell TT, Aantaa RE. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: a double-blind, randomized and placebo-controlled study. Br J Anaesth. 2006; 97(5):658-65.
[9] You H, Qiao H. Intraoperative neuromonitoring during resection of gliomas involving eloquent areas. Front Neurol. 2021; 12:658680.
[10] Lalenoh DC, Bisri T, Yusuf I. Brain protection effect of lidocaine measured by interleukin-6 and phospholipase A2 concentration in epidural haematoma with moderate head injury patient. J Anesth Clin Res. 2014; 5: 388
[11] Menon G, Nair S, Bhattacharya RN. Cerebral protection–Current concepts. Indian Journal of Neurotrauma. 2005; 2(02):67–79.
[12] Park YS, Koo YS, Ha S, Lee S, Sim JH, Kim JU. Total Intravenous Anesthesia Protocol for Decreasing Unacceptable Movements during Cerebral Aneurysm Clipping with Motor-Evoked Potential Monitoring: A Historical Control Study and Meta-Analysis. J Pers Med. 2023; 13(8):1266.
[13] Daniel C. Subarachnoid haemorrhage disease and the anaesthetist: the brain and neuroanaesthesia. Southern African Journal of Anaesthesia and Analgesia. 2010;16(1):60–8.
[14] Pong RP, Lam AM. Anesthetic management of cerebral aneurysm surgery. In: Cottrell & Patel’s Neuroanesthesia. Elsevier; 2025. p. 244–71.
Files | ||
Issue | Article in Press |
|
Section | Case Report(s) | |
Keywords | ||
aneurysm anesthesia clipping intraoperative monitoring |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |