• Yue Hu, Lu Ma, Yixuan Zong, Xiaofan Pang, and Yuan Fang.
• Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
• World Neurosurg. 2024 Nov 20.

ObjectiveSurgical management of blood-blister-like aneurysm(BBA) presents challenging and contentious due to high morbidity and mortality. Intraoperative neurophysiological monitoring(IONM) is a well-established tool in intracranial aneurysm surgeries while its application in BBA surgeries lacks report. This study retrospectively analyzes the utility of IONM in BBA surgeries between 2018 and 2023.MethodsWe utilized somatosensory and transcranial motor evoked potentials (SSEPs/tcMEPs) to monitor ischemia during operations. Neurological outcomes were mainly assessed through daily Glasgow Coma Scale, computed tomography within 24 hours and modified Rankin Scale at discharge.ResultsThirteen patients with ruptured BBAs (9 Tibetan, 4 Han; 10 females, 3 males; mean age: 55 years) underwent surgical procedures involved 10 clippings (6 direct, 2 wrapping-assisted, 2 balloon-assisted) and 3 trappings. There were 8 clipping procedures applied temporary arterial occlusion ranging from 5 to 125 minutes. Irreversible change of SSEPs/tcMEPs occurred in 3 clippings, all developed postoperative neurological deficits. Reversible signal change(RSC) of SSEPs occurred in 3 clippings with 1 neurological deficit. As for 3 trapping surgeries, all exhibited significant deficits regardless of RSC or unchanged signals in IONM.ConclusionsOur results demonstrate that IONM has low sensitivity (37.5%) and high specificity (100%) in detecting ischemic events during BBA surgery. The high rate of false-negative results in BBA-IONM suggests that its predictive value is limited particularly in complex maneuvers such as trapping and advanced vasoreconstruction, warranting cautious interpretation and further investigation of IONM modalities for BBA management.Copyright © 2024. Published by Elsevier Inc.

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