神经电生理监测在颅内动脉瘤血管内治疗中的应用

Application of neuroelectrophysiological monitoring in endovascular treatment of intracranial aneurysms

目的探讨神经电生理监测在颅内动脉瘤血管内治疗中应用。方法选取2015年10月~2018年6月南昌大学附属赣州医院收治的112例颅内动脉瘤血管内治疗患者作为研究对象,依据术中是否采用神经电生理监测将其分为两组,其中监测组42例,未监测组70例。按动脉瘤部位监测体感诱发电位(SEP)、运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)、头皮脑电图(EEG),采用改良Rankin量表(mRS)评分评估患者随访中的临床结局。对比分析两组患者术后24 h内新发神经功能障碍及术后6个月预后情况。结果监测组术中单纯SEP变化8例,SEP、EEG变化2例,SEP、EEG及MEP同时变化1例。监测组患者术后24 h内新发神经功能缺损发生率低于未监测组,差异有统计学意义(P<0.05)。两组患者术后6个月的预后比较,差异无统计学意义(P>0.05)。结论在颅内动脉瘤血管内治疗中,多模式神经电生理监测可以及时反映脑组织缺血,提高手术安全性,减少术后新发神经功能障碍的发生。

Objective To explore the application of neuroelectrophysiological monitoring in endovascular treatment of intracranial aneurysms.Methods A total of 112 patients with intracranial aneurysms treated in Ganzhou Hospital Affiliated to Nanchang University from October 2015 to June 2018 were selected as the research objects.They were divided into two groups according to whether neuroelectrophysiological monitoring was used during the operation.There were 42 patients in the monitoring group and 70 cases in the non-monitoring group.The somatosensory evoked potential(SEP),motorevoked potential(MEP),brainstem auditory evoked potential(BAEP)and scalp electroencephalography(EEG)were conducted depending on the location of the aneurysm and its associated vascular territory,the treatment outcome was evaluated using modified Rankin scale(mRS)score at follow-up.The postprocedural neurological deficits within 24 hours after operation and the prognosis at 6 months after operation in two groups were compared and analyzed.Results Intraoperative changes in SEP tracings alone were found in 8 patients in the monitoring group,SEP and EEG changes were noted in 2 patients.SEP,MEP and EEG changes were noted to be simultaneous in 1 patient.The prevalence of postprocedural neurological deficits within 24 hours after operation in the monitoring group was lower than that in the non-monitoring group,there was statistically signifcant difference(P<0.05).No statistical difference was found in the prognosis at 6 months after operation between the two groups(P>0.05).Conclusion In the endovascular treatment of intracranial aneurysms,multimodal neuroelectrophysiological monitoring can timely reflect brain tissue ischemia,improve the safety of surgery,and reduce the occurrence of postprocedural neurological deficits after operation.