诱发电位监测在脑血管病阻断性介入治疗中的应用

Evoked potential monitoring during endovascular treatment of cerebrovascular disease to prevent ischemic stroke induced by temporary occlusion of the feeding artery

目的探讨诱发电位监测在脑血管病阻断性介入治疗中的应用价值。方法 13例行阻断性介入治疗(包括球囊辅助栓塞、主干动脉闭塞)的脑血管病患者行术中全程诱发电位监测,观察是否出现脑缺血并调整策略。结果 7例颅内动脉瘤及1例颈内动脉海绵窦瘘行球囊闭塞试验后永久闭塞主干动脉。1例颈内动脉海绵窦段动脉瘤合并烟雾病者,球囊充盈95s内出现体感诱发电位异常改变,抽瘪球囊后波形恢复,据此调整球囊充盈时间并完成治疗,未发生缺血。5例颅内动脉瘤行球囊辅助弹簧圈栓塞成功。术后3d及出院时诱发电位监测均无缺血性波形改变。所有病例随访6个月,均无新发缺血事件;MRI检查示,除原发疾病外,未发现缺血性改变。结论作为反映脑组织缺血的灵敏指标,诱发电位监测可成为脑血管病阻断性介入治疗的常规辅助技术,以减少并发症,提高疗效。

Objective To explore the value of evoked potential monitoring to preventing ischemic stroke induced by the temporary occlusion of the feeding artery during the endovascular treatment of cerebrovascular diseases. Method In 13 patients with eerebrovascular diseases, the evoked potential monitoring was performed during the endovascular treatment in order to detect the ischemic changes induced by the temporary occlusion of the feeding arteries and to adjust the operative strategy in time. Results Seven patients with intracranial aneurysms and one patient with internal carotid cavernous fistula were successfully treated by the permanent occlusion of parent arteries after the temporary occlusion of the parent arteries with the balloons under the evoked potential monitoring. Balloon-assisted coils embolization was successfully performed in 5 patients with intracranial aneurysms, in whom, 1 with internal carotid artery aneurysm accompanied with Moyamoya disease underwent the adjustment of the duration of full balloon until the return of the somatosensory evoked potential （SEP） to normal because the abnormal change in SEP appeared after the temporary occlusion of the parent artery. The following-up 6 months after the operation showed that the postoperative ischemic stroke did not occur in all the patients. Conclusions The complications may be decreased and the curative effect of the endovasculor embolization on the cerebrovascular disease may be enhanced by the evoked potential monitoring which is sensitive to ischemic changes in brain tissues, and may be routinely used during the endovascular treatment of the eerebrovascular diseases.