The Importance of Sharing Intraoperative Monitoring Results to Avoid Complications during Aneurysm Clipping: A Case Report

Abstract

During clipping of an unruptured, right middle cerebral artery aneurysm in a 58-year-old woman, motor-evoked potential (MEP) findings were inconsistent with intraoperative indocyanine green (ICG) fluorescence angiography and Doppler results. After the first clipping, the MEP disappeared but the ICG and Doppler results appeared normal. As a result, a decision was made to perform cranial closure on the patient. Recognizing these discrepancies, the medical team shared the information and the anesthesiologist suspected left hemiparesis during the wake-up test. The anesthesiologist promptly adjusted the anesthetic depth, following which, the neurosurgeons performed a repeat craniotomy to remove the clip, resulting in normalization of the MEP. Reorienting the clip resolved the aneurysm and rectified the abnormal monitoring findings. The patient was then discharged without complications. This case highlights the possible challenges when subjective ICG and Doppler evaluations take precedence over objective MEP evaluations. To prevent complications, it is crucial to not only utilize various monitoring methods, but also share results across the medical team to implement appropriate treatments.