Is Two Really Better Than One? Examining the Superiority of Dual Modality Neurophysiological Monitoring During Carotid Endarterectomy: A Meta-Analysis

World Neurosurgery
Karthy ThiagarajanParthasarathy D Thirumala

Abstract

Periprocedural stroke after carotid endarterectomy increases long-term mortality. Intraoperative monitoring with electroencephalography (EEG) and somatosensory-evoked potentials (SSEPs) helps predict perioperative stroke risk. However, the sensitivity of each technique when used independently still remains low. The aim of this study is to determine whether multimodal monitoring leads to an increase in sensitivity and diagnostic accuracy. Relevant literature was obtained through a search of Embase, PubMed, and Web of Science databases and data were extracted. Data from the University of Pittsburgh Medical Center hospital records for the 2000-2012 period were included. Pooled estimates of sensitivity, specificity, and diagnostic odds ratio were obtained for single and multimodality neurophysiologic monitoring. A McNemar test was used to evaluate for any statistically significant differences in the sensitivities and false-positive rates. The diagnostic odds ratio of dual modality monitoring was found to be 17.4. The specificity of concurrent EEG and SSEP changes in predicting perioperative strokes was calculated to be 96.8% (95% confidence interval 94.1%-98.3%). The sensitivity of combined monitoring with a change in either modali...Continue Reading

References

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Citations

Sep 17, 2016·The American Journal of Cardiology·Aditya MuralidharanParthasarathy D Thirumala
Aug 16, 2016·Annals of Vascular Surgery·Natalie Domenick SridharanEfthymios D Avgerinos
Oct 31, 2018·Journal of Clinical Monitoring and Computing·Jeffrey H GertschUNKNOWN membership of the ASNM
Feb 9, 2020·Journal of Clinical Monitoring and Computing·Yasushi MotoyamaHiroyuki Nakase
Aug 18, 2020·Neurologia Medico-chirurgica·Masaaki UnoShunji Matsubara
Aug 14, 2021·The Journal of Thoracic and Cardiovascular Surgery·Ibrahim SultanThomas G Gleason

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