大型及巨大型颅内动脉瘤夹闭术中神经电生理监测的应用效果分析  

Application of neuroelectrophysiological monitoring in large and giant cranial aneurysm clipping: effect and analysis

作　　者：胡腾华[1] 王少兵[1] 刘红朝[1] 袁辉胜[1] 武锋[2] 何川[2] 

机构地区：[1]湖北省新华医院神经外科,湖北武汉430015 [2]湖北省新华医院神经功能科,湖北武汉430015

出　　处：《中华神经外科疾病研究杂志》2016年第2期113-116,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨大型及巨大型颅内动脉瘤直接夹闭术中神经电生理监测的应用效果。方法回顾性分析我院2013年1月至2015年1月直接开颅手术夹闭的大型及巨大型动脉瘤患者的临床资料共26例,术中均应用体感诱发电位(SEP)及运动诱发电位(MEP)监测。选取我院术中未应用电生理监测的大型及巨大型动脉瘤患者临床资料共25例做对照,比较两组患者动脉瘤夹闭效果及预后。结果应用神经电生理监测的26例中,术中电位均有异常改变并报警,术后动脉瘤夹闭不全4例,2例后交通动脉瘤患者因颈内动脉狭窄大面积脑梗塞死亡,2例前交通动脉瘤患者术后出现尾状核头梗塞,2例大脑中动脉瘤出现额叶非功能区梗塞。对照组25例中,3例后交通动脉瘤行孤立术,直接夹闭22例;夹闭不全6例,2例大脑中动脉瘤及1例后交通动脉瘤患者术后因大面积脑梗塞死亡,2例出现中央区梗塞;3例后交通动脉瘤患者出现内囊后肢梗塞,2例眼动脉瘤患者出现基底节区大面积梗塞。两组病例预后结果差异有显著统计学意义(P<0.05)。结论大型及巨大型颅内动脉瘤直接开颅夹闭术中应用神经电生理监测,对评估术中载瘤动脉塑形效果提供重要参考依据,能有效预防载瘤动脉狭窄,减少术后脑梗塞发生,提高手术效果。Objective The application of neuroelectrophysiological monitoring in large and giant cranial aneurysm clipping is investigated.Methods The clinical data of 26 patients with large and giant cranial aneurysm who underwent craniotomy clipping from January 2013 to January 2015 were analyzed retrospectively.The somatosensory evoked potential（ SEP） and motion evoked potential（ MEP） were monitored in these patients.A total of 25 patients who did not undergo neuroelectrophysiological monitoring were taken as control.The clipping of aneurysm and prognosis were discussed.Results The intra-operative SEP and MEP changes were observed in all the patients of the monitoring group.In monitoring group,4 aneurysms appeared incomplete clipping; 2 patients with posterior communicating artery aneurysm（ PCo AA） were dead because of large area cerebral infarction; 2 patients with anterior communicating artery aneurysm（ ACo AA） appeared cerebral infarction of caudate nucleus; and 2patients with middle cerebral artery aneurysm（ MCAA） appeared cerebral infarction in nonfunctional area of frontal lobe.Of the 25 patients without monitoring,3 aneurysms underwent isolated operation and 22 aneurysms were directly clipped.In control group,incompletely clipping appeared in 6 patients; 1 patient with PCo AA and 2 patients with MCAA were dead because of large area cerebral infarction; 2 patients appeared the central area infarction; 2 patients with PCo AA appeared cerebral infarction in posterior limb of internal capsule; large area cerebral infarction of basal ganglia appeared in 2 patients with ophthalmic aneurysms.There were statistical differences in prognosis between two groups（ P〈0.05）.Conclusion The application of neuroelectrophysiological monitoring in large and giant cranial aneurysm clipping may provide the important information for moulding of parent artery in operation.It can effectively avoid the narrowing of parent artery,reduce the ischemic complications and improve operative effect.

关 键 词：颅内动脉瘤 显微手术 神经电生理监测 

分 类 号：R743[医药卫生—神经病学与精神病学]