{"id":"6fe7f6e4-2da9-46db-b0e8-4182f19e8bb2","slug":"intraoperative-monitoring-for-spinal-radiculomedullary-artery-aneurysm-occlusion-treatment-what-when-and-how-long","title":"Intraoperative monitoring for spinal radiculomedullary artery aneurysm occlusion treatment: What, when, and how long?","authors":["Federico Landriel","Matteo Baccanelli","Santiago Hem","Eduardo Vecchi","Mariana Bendersky","Claudio Yampolsky"],"abstract":"Background: Spinal radiculomedullary artery aneurysms are extremely rare. Treatment should be tailored to clinical presentation, distal aneurysm flow, and lesion anatomical features. When a surgical occlusion is planned, it is necessary to evaluate whether intraoperative monitoring (IOM) should be considered as an indispensable tool to prevent potential spinal cord ischemia. Methods: We present a patient with symptoms and signs of spinal subarachnoid hemorrhage resulting from the rupture of a T4 anterior radiculomedullary aneurysm who underwent open surgical treatment under motor evoked potential (MEP) monitoring. Results: Due to the aneurysmal fusiform shape and preserved distal flow, the afferent left anterior radiculomedullary artery was temporarily clipped; 2 minutes after the clamping, the threshold stimulation level rose higher than 100 V, and at minute 3, MEPs amplitude became attenuated over 50%. This was considered as a warning criteria to leave the vessel occlusion. The radiculomedullary aneurysm walls were reinforced and wrapped with muscle and fibrin glue to prevent re-bleeding. The patient awoke from general anesthesia without focal neurologic deficit and made an uneventful recovery with complete resolution of her symptoms and signs. Conclusion: This paper attempts to build awareness of the possibility to cause or worsen a neurological deficit if a radiculomedullary aneurysm with preserved distal flow is clipped or embolized without an optimal IOM control. We report in detail MEP monitoring during the occlusion of a unilateral T4 segmental artery that supplies an anterior radiculomedullary artery aneurysm.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/6fe7f6e4-2da9-46db-b0e8-4182f19e8bb2/featured/hero-1782420796988.png","publishDate":"2017-09-06T00:00:00.000Z","doi":"10.4103/sni.sni_385_16","categories":["Neurovascular","Technical Note"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2017/09/8604/SNI-8-211.pdf"}