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Somatosensory evoked potential (SEP) monitoring is a standard tool during clipping of aneurysms of the middle cerebral artery (MCA), and the parameter used to detect a state of cortical ischemia is amplitude. We think that the sensitivity of SEP can however be improved by using other parameters. Our study moves in this direction via SEP morphology. In this pilot preliminary study, involving a small sample without postoperative neurological deficit, we aimed at investigating the value of SEP morphology (in the 15- to 35-ms time frame), in comparison with SEP amplitude (N20 peak-to-peak), as a measure of sensitivity to blood flow reduction. The changes in the SEP morphology of 16 patients undergoing clipping of an unruptured MCA aneurysm was studied. We applied the Morph-Fréchet index for each recorded SEP (at 30-second intervals), quantifying the pattern shape change with regard to the average SEP recorded after dura opening (baseline). We also compared 3 measurements of the SEP morphology, without and with GARCH-derived filter. Filtered Morph-Fréchet never exceeded the individual’s “normality” range in baseline but did so in 81% of the risk phase on average across the 16 subjects, which is more than that for amplitude (36%, P = .002). This pilot study indicates that a measurement derived from the networking nature of the brain was sensitive to blood flow reduction. The SEP morphology approach promises to improve SEP monitoring sensitivity during clipping of unruptured MCA aneurysms. New and Noteworthy. The higher sensitivity to blood flow reduction of SEP morphology than amplitude promises to improve the effectiveness of intraoperative monitoring during MCA aneurysm clipping procedures.

Clipping of cerebral aneurysms often involves manipulation or temporary occlusion of the parent vasculature, which may lead to postoperative neurological sequelae1,2. Somatosensory evoked potential (SEP) is a standard procedure to monitor integrity of the perfusion within the middle cerebral artery (MCA) territory3,4. Nevertheless, the SEP monitoring sensitivity to postoperative neurologic deficits deserve improvements, as the results of a recent review with a sample size equal to 2015 suggest 4. In this pilot preliminary study, in a small sample without post-operative deficits, we aimed at investigating the value of SEP morphology, in comparison with the SEP amplitude.

To date, the videofluoroscopic swallowing study (VFSS) is considered the gold standard for thoroughly assessment and management of dysphagia. It is a symptom so common and diverse that is often considered as a disease in its own right. Dysphagia severity can range from a trivial problem to a lethal condition. It can seriously compromise the quality of life of affected patients, therefore management should be prompt. The implications of dysphagia in healthcare costs are elevated. VFSS carries a degree of subjectivity in its interpretation. The aim of present work is to implement a new software tool for video image processing in VFSS that assesses the superior and anterior excursions of the larynx. Currently, the radiologist have to identify manually the interest points, to rotate the images, to draw by hand the axes and to assess on these axes the projections related to the laryngeal displacements. This study demonstrates that the new software tool evaluates the components of the laryngeal elevation in the sagittal plane of the dysphagic patient minimizing the manual intervention of the radiologist.