Use of Somatosensory Evoked Potentials to Detect and Prevent Impending Brachial Plexus Injury during Surgical Positioning for the Treatment of Supratentorial Pathologies

ABSTRACT.

Somatosensory evoked potentials (SSEPs) are widely utilized for the intraoperative detection and prevention of nerve conduction injuries. Their use in identifying position-related injuries to the brachial plexus in patients undergoing supine craniotomies for the treatment of supratentorial pathology is not well documented. This case series describes three instances of unilateral upper extremity SSEP changes in patients positioned for supine craniotomies. In all three cases SSEP responses improved after repositioning. None of the patients exhibited new neurological deficits post-operatively. This case series highlights the importance of vigilant monitoring in the period after final positioning and demonstrates the usefulness of SSEPs as a tool to aid in the early detection and prevention of impending position-related nerve injury.

KEY WORDS.:

• Amygdalohippocampectomy
• craniotomy
• diabetes mellitus
• hypertension
• intraoperative neurophysiological monitoring
• obesity
• positional brachial plexus injury
• somatosensory evoked potentials
• supratentorial lesion