Rare Complication of Bite Injury Following Coil Embolization Using Transcranial Motor-evoked Potential Monitoring: A Case Report

Abstract

Objective: A bite injury, a rare complication of electrical stimulation via transcranial motor-evoked potential (TCMEP) monitoring during coil embolization of cerebral aneurysm, is reported.

Case Presentations: A 53-year-old man presented with sudden-onset headache and dizziness. A dissecting aneurysm of the left posterior inferior cerebellar artery and cerebral infarction were noted on MRI examination. Stent-assisted coil embolization was subsequently performed under TCMEP monitoring. A tongue laceration and tooth defect associated with electrical stimulation occurred, and surgical closure of tongue laceration was required for hemostasis.

Conclusion: Endovascular treatment is often performed under antithrombotic therapy, and bleeding in even minor wounds is often difficult to stop in such a condition as in the presented case. TCMEP should be done with a specific care for the bite injury, for example, special attention should be given to tongue position to avoid bite injury, and a soft bite block and a teeth guard should be used.