Szelényi Andrea, Bueno de Camargo Adauri, Flamm Eugene, Deletis Vedran
Division of Intraoperative Neurophysiology, Adult Neurosurgery, Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York, USA.
J Neurosurg. 2003 Sep;99(3):575-8. doi: 10.3171/jns.2003.99.3.0575.
The value of motor evoked potentials (MEPs) as an intraoperative neurophysiological monitoring tool for detecting selective subcortical ischemia of the motor pathways during intracerebral aneurysm repair is described and the use of such measures to predict postoperative motor status is discussed. The authors present the case of a 64-year-old woman in whom there was an incidental finding of two right middle cerebral artery (MCA) aneurysms. During the aneurysm clipping procedure, an intraoperative MEP loss in the left abductor pollicis brevis and tibial anterior muscles occurred during an attempt at permanent clip placement. There were no concurrent changes in somatosensory evoked potentials. Postoperatively, the patient demonstrated a left hemiplegia with intact sensation. A computerized tomography scan revealed an infarct in the anterior division of the MCA territory, including the posterior limb of the internal capsule. In this patient, intraoperative neurophysiological monitoring with MEPs has been shown to be a sensitive tool for indicating subcortical ischemia affecting selective motor pathways in the internal capsule. Therefore, intraoperative loss of MEPs can be used to predict postoperative motor deficits.
本文描述了运动诱发电位（MEP）作为一种术中神经生理监测工具，在颅内动脉瘤修复过程中检测运动通路选择性皮质下缺血的价值，并讨论了使用此类测量方法预测术后运动状态的情况。作者介绍了一名64岁女性的病例，该患者偶然发现右侧大脑中动脉（MCA）有两个动脉瘤。在动脉瘤夹闭手术过程中，在尝试永久夹闭时，左侧拇短展肌和胫前肌出现术中MEP消失。体感诱发电位没有同时发生变化。术后，患者出现左侧偏瘫但感觉完好。计算机断层扫描显示MCA区域前部分梗死，包括内囊后肢。在该患者中，术中使用MEP进行神经生理监测已被证明是一种敏感的工具，可用于指示影响内囊选择性运动通路的皮质下缺血。因此，术中MEP消失可用于预测术后运动功能障碍。
