Utility of evoked potentials during anterior cerebral artery and anterior communicating artery aneurysm clipping

•For anterior cerebral artery aneurysm clipping dual SSEPs and tcMEPs enhance detection of lower extremity deficits.•Evoked potentials have limited utility in predicting upper extremity deficits related to subcortical ischemia.•Four-extremity dual-modality monitoring can also detect pathogenetic mechanisms that are remote from the surgical site.