神经生理监测在介入治疗合并动脉狭窄或痉挛的颅内动脉瘤中的应用  

Treatment for cerebral aneurysms with stenosis or spasm under neurophysiological monitoring

作　　者：唐海涛[1] 赵江[1] 鲁春鹤[1] 王晓民[1] 王玉春[1] 付振宇[1] 范春红[1] 

机构地区：[1]黑龙江省大庆市大庆油田总医院神经外科,163001

出　　处：《中华神经外科杂志》2014年第3期225-228,共4页Chinese Journal of Neurosurgery

摘　　要：目的通过术中应用神经电生理监测治疗合并血管痉挛或狭窄的颅内动脉瘤来讨论术中应用的意义。方法本次研究对28例患者在术中应用神经电生理监测技术时出现波形变化，并对神经介入治疗颅内动脉瘤的术中患者电生理变化做出正确的判断，做出及时调整，如扩容、提高血压、解痉甚至暂时停止手术进程等措施，使术者顺利完成颅内动脉瘤的治疗，将手术并发症减至最小。结果28例患者中术前有10例狭窄，18例血管痉挛。术中由于载瘤动脉狭窄，有4例患者神经电生理波形出现明显下降，在18例血管痉挛的患者中，有14例出现波形下降50％，给予及时扩容、提高血压、解痉甚至暂时停止手术进程等措施，所有患者的神经电生理波形均恢复正常。术后3例患者遗留神经功能缺损，随访72h后均恢复正常。结论在颅内动脉瘤神经介入治疗中应用神经电生理监测，可以大大减少术后并发症的发生，可以提高手术的成功率。Objective To study the significance of the application of intraoperative neurophysiological monitoring in the endovascular treatment for intracranial aneuryms with vasospasm or stenosis. Methods Intraoperative neurophysiological monitoring was performed during the endovascular treatment for 28 patients of intracranial aneuryms with vasospasm or stenosis. The in - time adjustments, such as capacity enlargement, blood pressure increasing, spasmolysis or even stopping the procedure, were performed according to the neurophysiologieal variation o~ the patients so as to make the endovascular procedure successfully and reduce the post - operative complications. Results There were 10 patients of stenosis and 18 patients of vasospasm. The neurophysiological waves were obviously reduced in 4 patients with parental artery stenosis, and reduced for 50% in 14 patients out of 18 patients with vasospasm. After appropriate management, the neurophysiological waves of all the patients were recovered to the normal conditions. There were 3 patients with hemiplegia after the operation, and they recovered after 72 hours. Conclusions The application of the intraoperative neurophysiological monitoring during the neurointervention treatment of intracranial aneuryms could reduce the post - operative complications greatly and increase the successful rate of the operation.

关 键 词：神经电生理监测 颅内动脉瘤 神经介入治疗 血管痉挛 血管狭窄 

分 类 号：R743.35[医药卫生—神经病学与精神病学]