Can evoked potential changes during the superficial temporal artery-middle cerebral artery bypass surgery predict postoperative improvement of cerebral perfusion and functional status?

Abstract

Background: We investigated evoked potential (EP) changes during superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery and their correlations with imaging and clinical findings postoperatively. Methods: This retrospective study included patients who underwent STA-MCA bypass surgery due to ischemic stroke with large artery occlusion (MB group). Patients who underwent unruptured MCA aneurysm clipping were enrolled in the control group (MC group). Median and tibial somatosensory evoked potentials (SSEP), and motor evoked potentials recorded from the abductor pollicis brevis (APB-MEP) and abductor hallucis (AH-MEP) were measured intraoperatively. Modified Rankin scale (mRS) and perfusion-weighted imaging (PWI) related variables, i.e., mean transit time (MTT) and time to peak (TTP), were assessed. Results: ∆median SSEP, ∆APB-MEP, and ∆AH-MEP were significantly higher in the MB group than in the MC group (p = 0.027, p = 0.006, and p = 0.015, respectively). APB-MEP and AH-MEP amplitudes were significantly increased at the final measurement (p = 0.010 and p < 0.001, respectively). The ∆TTP asymmetry index was moderately correlated with ∆APB-MEP (r = 0.573, p = 0.005) and ∆AH-MEP (r = 0.617, p = 0.002). ∆APB-MEP was moderately correlated with ∆MTT (r = 0.429, p = 0.047) and ∆mRS at 1 month (r = 0.514, p = 0.015). Conclusions: MEP improvement during STA-MCA bypass surgery was partially correlated with PWI and mRS and could reflect the recovery in cerebral perfusion.