术中经颅电刺激运动诱发电位监测评估颅内动脉瘤术后运动功能

Assessment of intraoperative motor-evoked potentials for predicting postoperative motor function during the surgical clipping of intracranial aneurysms

目的：探讨经颅电刺激运动诱发电位（MEP）监测颅内动脉瘤患者运动功能缺损的应用价值。方法i69例颅内动脉瘤夹闭手术患者，术中行MEP监测，比较术前及术后神经功能的改变和MEP变化之间的关系。结果：69例患者中9例表现出MEP的异常，其中6例术中采取相应措施后，1～40min内MEP逐渐恢复正常，术后未出现新发神经功能障碍。手术结束时3例MEP未能恢复到基线水平，与术后神经功能障碍的发生具有一致性。结论：MEP的改变可较早地获得脑缺血的证据，预测患者术后肢体功能障碍，指导载瘤动脉的临时阻断时间。经颅电刺激面神经运动诱发电位（FNMEP）在巨大及复杂动脉瘤术中是一种安全、有效地监测面神经通路完整性的手段。

Objective： To evaluate the usefulness of monitoring transcranial electrically stimulated motor evoked potential （MEP） and its impact on postoperative motor function after surgical clipping of intracranial aneurysms. Methods： A total of 69 aneurysm patients were monitored for MEP during surgery. The postoperative and preoperative neurological function variation and the correlation between them were compared. Results： MEP deteriorated in 9/68 patients, 6 of the deteriorated MEP returned to normal within 1-40 min, and no new motor deficit emerged. 3 of MEP failed to return to the baseline, which were consistent with postoperative motor function deficit. Conclusion： Changes in MEP could serve as early indication of the cerebral ischemia, predicting postoperative motor function and providing a guide to a safe time for temporary clipping. FNMEP monitoring is a safe and reliable tool for the integrity of facial nerve pathway in giant aneurysm surgery.