• Hyoung Soo Byoun, Chang Wan Oh, O-Ki Kwon, Si Un Lee, Seung Pil Ban, Sung Hoon Kim, Tackeun Kim, Jae Seung Bang, Sung Un Kim, Jongsuk Choi, and Kyung Seok Park.
• Department of Neurosurgery, Chungnam National University Hospital, Daejeon, South Korea.
• Clin Neurol Neurosurg. 2019 Nov 1; 186: 105503.

ObjectiveTo investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm.Patients And MethodsFrom January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated.ResultsIschemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972-1.000), PPVs; 100% (95% CI = 0.055-1.000), and NPVs; 93% (95% CI = 0.945-0.973) with low sensitivity; 11.1% (95% CI = 0.006-0.111) were calculated.ConclusionsIONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.Copyright © 2019. Published by Elsevier B.V.

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