Navigating a grey zone: Neuromonitoring in the management of temporary internal carotid artery occlusion techniques - A case series and literature review

There is a dearth of clearly defined thresholds to guide the application of neuromonitoring modalities in temporary vessel occlusion techniques. We report a case series exploring the utility of various neuromonitoring techniques during temporary vessel occlusion procedures. We conducted a retrospective chart review of patients, who underwent temporary vessel occlusion procedures over a two-year period and examined the neuromonitors employed in temporary vessel occlusion procedures including balloon occlusion test (BOT). We found complete details of nine patients, who were managed with the use of the following neuromonitors: cerebral oximetry, electrical activity monitors, evoked potential monitors, and transcranial Doppler. A literature search identified other studies reporting utilization of adjuvant neuromonitoring in these procedures. Although multiple sensors could be concurrently attached to patients without impeding image acquisition in patients undergoing BOT, our review of the literature and our own findings revealed a lack of consistent correlation with outcome, particularly concerning near-infrared spectroscopy values.