Intraoperative Neurophysiological Monitoring during Circulatory Arrest Using Deep Hypothermia: A Case Report during Brain Aneurysm Clipping

ABSTRACT.

Neuroprotection is the main goal during procedures that involve circulatory arrest using hypothermia. This case report describes the role intraoperative neurophysiological monitoring (IONM) plays and describes the sensitivity of specific modalities used intraoperatively to identify changes and intervene in a timely manner. Understanding the contributing factors and IONM changes during hypothermia helps the neuroelectrophysiology monitorist and the surgeon to provide optimal care while minimizing morbidity. In this report we describe the role of IONM from the monitorist's perspective, describing the surgical procedure and the sequence of events. This report illustrates the electrophysiological changes that occur during aneurysm clipping during cardiopulmonary arrest with deep hypothermia.

KEY WORDS.:

• Aneurysm
• brainstem auditory evoked potentials
• cardiopulmonary arrest
• electrocerebral silence
• hypothermia
• intraoperative neurophysiological monitoring
• somatosensory evoked potentials
• transcranial electric motor evoked potentials