神经电生理监测在颅内多发动脉瘤的一期手术中的应用  

Application neurophysiological monitoring during one-stage surgical clipping for multiple intracranial aneurysms

作　　者：梁玉红 张文芳 陈锋 周毅 彭鹏 胡克琦 LIANG Yu-hong;ZHANG Wen-fang;CHEN Feng;ZHOU Yi;PENG Peng;Hu Ke-qi(Department of Neurosurgery,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Sciences,Xiangyang 441021,China)

机构地区：[1]湖北文理学院附属医院/襄阳市中心医院神经外科,湖北襄阳441021

出　　处：《中国临床神经外科杂志》2024年第1期16-18,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨神经电生理监测(NPM)技术在颅内多发动脉瘤(MIA)一期手术中的应用价值。方法回顾性分析2018年1月至2022年6月NPM辅助下一期手术治疗的30例MIA的临床资料。术前行颅脑CT平扫、CTA和/或DSA检查确诊,术中动态监测体感诱发电位(SEP)、运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)和脑电图(EEG)。结果30例共发现69个动脉瘤,其中23例有2个动脉瘤,5例有3个动脉瘤,2例有4个动脉瘤;动脉瘤直径<0.5 cm有11个,0.5~1.5 cm有28个,1.5~2.5 cm有25个,≥2.5 cm有5个。术后复查CTA示69个动脉瘤均完全夹闭,载瘤动脉通畅。25例术中NPM指标正常;5例在临时阻断时指标异常,采取干预措施后,3例监测波形恢复正常,术后肢体功能无异常;2例下肢SEP未恢复至基线水平,术后下肢肌力4级。术后随访3个月,2例术中NPM指标正常者术后存在肢体运动功能障碍,1例左上肢肌力2级、左下肢肌力3级,GOS评分3分;另1例左侧上、下肢肌力均为3级,GOS评分4分;其余28例中,GOS评分3分4例,4分6例,5分18例。结论一期手术治疗MIA时,术中NPM技术对相关缺血事件具有预警作用,及时处理能够避免和降低手术操作导致的神经功能损伤。Objective To investigate the application value of neuroelectrophysiological monitoring(NPM)in one-stage surgical clipping for patients with multiple intracranial aneurysms(MIA).Methods The clinical data of 30 MIA patients underwent one-stage surgical clipping under guidance NPM from January 2018 to June 2022 were retrospectively analyzed.Preoperative brain CT scan,CTA and/or DSA were performed to confirm the diagnosis.During the operation,somatosensory evoked potential(SEP),motor evoked potential(MEP),brainstem auditory evoked potential(BAEP)and electroencephalogram(EEG)were dynamically monitored.Results A total of 69 aneurysms were found in 30 patients,of whom 23 had 2 aneurysms,5 had 3 aneurysms,and 2 had 4 aneurysms.There were 11 aneurysms with a diameter<0.5 cm,28 aneurysms with a diameter of 0.5~1.5 cm,25 aneurysms with a diameter of 1.5~2.5 cm,and 5 aneurysms with a diameter≥2.5 cm.Postoperative CTA showed that all aneurysms of 30 patients were completely clipped,and the parent arteries were patency.NPM parameters were normal in 25 patients and abnormial in 5 patients,of whom the NPM parameters returned to normal in 3 patients and did not in 2 after treatment,during the temporary blockade of parent arteries.Three months after operation,2 patients with normal NPM parameters had limb motor dysfunction with a GOS score of 3 and 4,respetively.Of the other 28 patients,4 patients had a GOS score of 3,6 patients of 4,and 18 patients of 5.Conclusions During the one-stage surgical clipping for patients with MIA,the intraoperative NPM technique has an early warning effect on related ischemic events,and timely treatment can avoid and reduce nerve function injury caused by operation.

关 键 词：颅内多发动脉瘤 神经电生理监测 显微手术 一期手术 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]