Somatosensory evoked potential monitoring during the management of aneurysmal SAH.

Somatosensory evoked responses to median nerve stimulation have been recorded during the management of subarachnoid hemorrhage from intracranial aneurysms. The type of measurement was central conduction time (CCT), the time interval between the N14 peak (at C-2) and the N20 peak (at the cortex). Significant differences were found between patients with aneurysms in clinical Grade 4 and normal individuals, although there was no significant difference between most aneurysm patients in Grades 1 through 3. The prolongation of CCT was found of prognostic value. Significant prolongation (mean plus two standard deviations) from the normal period of 5.4 +/- 0.4 msec was found significantly useful to predict a less than satisfactory outcome (a patient with neurological signs or disabled) at 2 months, and these differences were detectable as early as 48 hours postoperatively. Differences between conduction time in the two hemispheres could also be used prognostically, although the significance of the differences did not appear until 48 to 72 hours after surgery, and was in any event less than that of CCT.