Use of Intraoperative Evoked Potentials for Spinal Cord Monitoring During Aortic Aneurysm Surgery: A Meta-analysis and Systematic Review

Introduction: Surgery for aortic aneurysms still carries a high risk of spinal cord damage (SCI), which frequently leads to severe morbidity. By giving real-time input on spinal cord integrity, intraoperative evoked potential monitoring has become more and more popular as a way to reduce this risk. However, variable reporting of results and variations in monitoring techniques make evaluating its efficacy more difficult. By identifying gaps in the data and suggesting guidelines for standardized monitoring procedures, this systematic review and meta-analysis seeks to assess the effectiveness of intraoperative evoked potentials monitoring in decreasing the incidence of SCI after aortic aneurysm repairs.

Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines, including original studies that involved intraoperative evoked potentials monitoring for brain aneurysm surgery. Comprehensive searches were performed across multiple databases, including Cochrane, PubMed, and EMBASE. A total of 602 articles were identified, with 55 duplicates removed, resulting in 547 unique studies. After further elimination of 6 additional duplicates using the RAYYAN platform, 541 articles were available for selection. Ultimately, 22 studies were incorporated into the final evaluation, concentrating on clinical results and safety metrics.

Results: A total of 22 studies from 2000 onward were analyzed, revealing significant deficiencies in reporting patient comorbidities, treatment protocols, and follow-up outcomes. High heterogeneity was observed, particularly regarding the techniques used for intraoperative monitoring. Sensitivity for somatosensory-evoked potentials (SSEP) ranged from 33% to 100%, while motor-evoked potentials (MEP) had a sensitivity of up to 100%. Specificity for MEPs was consistently high, ranging from 85% to 100%. Recent studies demonstrate improvements in monitoring efficacy, yet gaps remain in the standardization of reporting practices, as only a fraction of studies documented critical procedural details.

Conclusion : The findings indicate a pressing need for standardized guidelines to enhance reporting rigor in studies involving intraoperative monitoring during aortic surgeries. Addressing these gaps will facilitate improved comparability and potentially better clinical outcomes in the management of spinal cord injuries.