Liu Amon Y, Lopez Jaime R, Do Huy M, Steinberg Gary K, Cockroft Kevin, Marks Michael P
Stanford University Medical Center, Stanford, CA, USA.
AJNR Am J Neuroradiol. 2003 Sep;24(8):1520-7.
Endovascular aneurysm therapy has associated risks of ischemic complications. We undertook this study to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms.
Thirty-five patients underwent NPM during endovascular treatment of cerebral aneurysms. The patients underwent a total of 50 endovascular procedures, including balloon test occlusion (19 patients), GDC embolization (22 patients), and permanent vessel occlusion (nine patients). NPM included electroencephalography, somatosensory evoked potentials, and/or brain stem auditory evoked potentials, depending on the location of the aneurysm.
NPM changes were seen in nine (26%) of 35 patients and altered the management in five (14%) of 35 patients. In three of the five cases, NPM changes were observed without corresponding neurologic physical examination changes after balloon test occlusion (performed while the patients were under general anesthesia in two cases). In the two other cases in which NPM changes altered management, ischemia was detected at the time of intra-aneurysmal therapy while the patients were under general anesthesia. Overall, 18 of 35 patients underwent a total of 19 balloon test occlusion procedures. Of the 17 remaining patients, 13 underwent aneurysm coiling, two were not treated because of inability to safely place coils, and two were treated for distal aneurysms. Two patients developed transient neurologic deficits without concurrent NPM changes, representing false-negative NPM test results.
NPM is a valuable adjunct to endovascular treatment of cerebral aneurysms. Our study suggests that these monitoring techniques may reduce ischemic complications and can be used to help guide therapeutic decisions.
血管内动脉瘤治疗存在缺血性并发症相关风险。我们开展本研究以评估神经生理学监测（NPM）技术在检测脑血管内治疗动脉瘤期间可能出现的缺血性变化方面的疗效。
35例患者在脑血管内治疗动脉瘤期间接受了NPM。患者共接受了50次血管内手术，包括球囊试验闭塞（19例患者）、GDC栓塞（22例患者）和永久性血管闭塞（9例患者）。根据动脉瘤位置，NPM包括脑电图、体感诱发电位和/或脑干听觉诱发电位。
35例患者中有9例（26%）出现NPM变化，且改变了5例（14%）患者的治疗方案。在5例中的3例中，球囊试验闭塞后（2例在全身麻醉下进行）观察到NPM变化但无相应的神经体格检查变化。在另外2例NPM变化改变治疗方案的病例中，在动脉瘤内治疗时全身麻醉状态下检测到缺血。总体而言，35例患者中有18例共接受了19次球囊试验闭塞手术。其余17例患者中，13例接受了动脉瘤栓塞，2例因无法安全放置弹簧圈未接受治疗，2例治疗远端动脉瘤。2例患者出现短暂性神经功能缺损但无NPM变化，代表NPM检测结果为假阴性。
NPM是脑血管内动脉瘤治疗的有价值辅助手段。我们的研究表明，这些监测技术可能减少缺血性并发症，并可用于帮助指导治疗决策。
