Ritz Rainer, Schwerdtfeger Karsten, Strowitzki Martin, Donauer Erich, Koenig Jochem, Steudel Wolf-Ingo
Department of Neurosurgery, University of Saarland, Germany.
Neurol Res. 2002 Dec;24(8):756-64. doi: 10.1179/016164102101200852.
We evaluate the prognostic value of somatosensory evoked potentials (SSEP) in poor-grade patients after early surgery for aneurysmal subarachnoid hemorrhage compared to the Hunt and Hess (H&H) and WFNS scales. Ninety patients with angiographically proven aneurysms graded H&H IV or V were evaluated retrospectively. The aneurysms of 72 patients were clipped. In 53 out of 72 patients 147 SSEP examinations were recorded. The SSEP were classified according to the central conduction time (CCT) and the number of cortical potentials. Outcome was determined according to the Glasgow Outcome Scale. To evaluate the predictability of the SSEP to clinical grading scales receiver operating characteristic (ROC) analysis was done. The H&H scale did not demonstrate statistically significant predictability for poor-grade patients. The WFNS scale predicted the outcome for only one group (survival/death) (p = 0.035). Predictability of outcome by the SSEP was statistically confirmed. Normal CCT indicated a potential for a good recovery, but not consistently so. Bilaterally enhanced CCT was predictive of a poor outcome. Bilateral lack of cortical responses was always related to fatal outcome. ROC analysis confirmed that SSEP are superior to clinical grading scales in determining prognosis in poor-grade patients. In doubt, whether early aneurysm surgery or conservative treatment in a poor-grade patient should be done, SSEP will be helpful.
我们评估了体感诱发电位（SSEP）在动脉瘤性蛛网膜下腔出血早期手术后低分级患者中的预后价值，并与Hunt和Hess（H&H）分级及世界神经外科联盟（WFNS）分级进行比较。对90例经血管造影证实为H&H IV级或V级动脉瘤的患者进行回顾性评估。72例患者的动脉瘤进行了夹闭。在72例患者中的53例记录了147次SSEP检查。SSEP根据中枢传导时间（CCT）和皮质电位数量进行分类。根据格拉斯哥预后量表确定预后。为评估SSEP对临床分级量表的预测能力，进行了受试者操作特征（ROC）分析。H&H分级对低分级患者未显示出统计学上显著的预测能力。WFNS分级仅对一组（生存/死亡）的预后有预测作用（p = 0.035）。SSEP对预后的预测能力经统计学证实。正常的CCT表明有良好恢复的可能性，但并非始终如此。双侧CCT延长提示预后不良。双侧缺乏皮质反应总是与致命结局相关。ROC分析证实，在确定低分级患者的预后方面，SSEP优于临床分级量表。在怀疑低分级患者应进行早期动脉瘤手术还是保守治疗时，SSEP会有帮助。
