Abstract:Objective To explore the application of neuroelectrophysiological monitoring in endovascular treatment of intracranial aneurysms.Methods A total of 112 patients with intracranial aneurysms treated in Ganzhou Hospital Affiliated to Nanchang University from October 2015 to June 2018 were selected as the research objects.They were divided into two groups according to whether neuroelectrophysiological monitoring was used during the operation.There were 42 patients in the monitoring group and 70 cases in the non-monitoring group.The somatosensory evoked potential (SEP),motorevoked potential (MEP),brainstem auditory evoked potential (BAEP) and scalp electroencephalography (EEG)were conducted depending on the location of the aneurysm and its associated vascular territory,the treatment outcome was evaluated using modified Rankin scale (mRS) score at follow-up.The postprocedural neurological deficits within 24 hours after operation and the prognosis at 6 months after operation in two groups were compared and analyzed..Results Intraoperative changes in SEP tracings alone were found in 8 patients in the monitoring group,SEP and EEG changes were noted in 2 patients.SEP,MEP and EEG changes were noted to be simultaneous in 1 patient.The prevalence of postprocedural neurological deficits within 24 hours after operation in the monitoring group was lower than that in the non-monitoring group,there was statistically signifcant difference (P<0.05).No statistical difference was found in the prognosis at 6 months after operation between the two groups (P>0.05).Conclusion In the endovascular treatment of intracranial aneurysms,multimodal neuroelectrophysiological monitoring can timely reflect brain tissue ischemia,improve the safety of surgery,and reduce the occurrence of postprocedural neurological deficits after operation.
Ghadirpour R,Nasi D,Iaccarino C,et al.Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors:predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience[J].J Neurosurg Spine,2018,30(2):259-267.
[5]
van Swieten JC,Koudstaal PJ,Visser MC,et al.Interobserver agreement for the assessment of handicap in stroke patients[J].Stroke,1988,19(5):604-607.
[6]
Church EW,Rohatgi P,Feidt AE,et al.Neurophysiological monitoring during arteriovenous malformation embolization[J].Oper Neurosurg,2019,17(5):503-508.
[7]
Bican O,Cho C,Lee L,et al.Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization[J].Clin Imaging,2018,51(9):155-159.
[8]
Salame K,Maimon S,Regev GJ,et al.Electrophysiological monitoring during preoperative angiography to guide decisions regarding permanent occlusion of major radicular arteries in patients undergoing total en bloc spondylectomy[J].Neurosurg Focus,2016,41(2):E19.
[9]
Ares WJ,Grandhi R,Panczykowski DM,et al.Diagnostic Accuracy of Somatosensory Evoked Potential Monitoring in Evaluating Neurological Complications During Endovascular Aneurysm Treatment[J].Oper Neurosurg,2018,14(2):151-157
[10]
Cohen,Michael X.Where Does EEG Come From and What Does It Mean?[J].Trends Neurosci,2017,40(4):208-218.
[11]
López JR.The use of evoked potentials in intraoperative neurophysiologic monitoring[J].Phys Med Rehabil Clin N Am,2004,15(1):63-84.
[12]
Wiske CP,Arhuidese I,Malas MB,et al.Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database[J].J Vasc Surg,2018,68(2):416-425.
[13]
Azad TD,Pendharkar AV,Nguyen V,et al.Diagnostic Utility of Intraoperative Neurophysiological Monitoring for Intramedullary Spinal Cord Tumors:Systematic Review and Meta-Analysis[J].Clin Spine Surg,2018,31(3):112-119.
[14]
Li Z,Fan X,Wang M,et al.Prediction of postoperative motor deficits using motor evoked potential deterioration duration in intracranial aneurysm surgery[J].Clin Neurophysiol,2019,130(5):707-713.
[15]
Satow T,Ikeda G,Takahashi J,et al.Coil Embolization for Unruptured Intracranial Aneurysms at the Dawn of Stent Era:.Results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3[J].Neurol Med Chir,2020,60(2):55-65.
[16]
Horton TG,Barnes M,Johnson S,et al.Feasibility and efficacy of transcranial motor-evoked potential monitoring in neuroendovascular surgery[J].AJNR Am J Neuroradiol,2012,33(9):1825-1831.
[17]
Chung J,Park W,Hong SH,et al.Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms:evaluation of falsepositive and false-negative cases[J].J Neurosurg,2018,130(3):936-948.
Phillips JL,Chalouhi N,Jabbour P,et al.Somatosensory Evoked Potential Changes in Neuroendovascular Procedures:Incidence and Association With Clinical Outcome in 873 Patients[J].Neurosurgery,2014,75(5):560-567.
[20]
Lee S,Kim DY,Kim SB,et al.Predictive value of neurophysiologic monitoring during neurovascular intervention for postoperative new neurologic deficits[J].Neuroradiology,2019,61(2):207-215.