Yeon Je Young, Seo Dae-Won, Hong Seung-Chyul, Kim Jong-Soo
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Neurol Sci. 2010 Jun 15;293(1-2):29-34. doi: 10.1016/j.jns.2010.03.013. Epub 2010 Apr 20.
The aim of the present study was to evaluate the usefulness of transcranial motor evoked potential (MEP) monitoring and its impact on morbidity after surgical clipping of unruptured intracranial aneurysms.
Motor outcomes were compared before and after the application of MEP monitoring for a one year period. A total intravenous anesthesia was induced and maintained with a continuous infusion of vecuronium. Muscle MEPs were elicited by constant voltage stimulation via subdermal needle electrodes placed at C3 and C4 positions. A more than 50% decrement of MEP amplitudes compared with baseline recordings was regarded as a warning sign and promptly indicated to the surgeon.
Before the application of MEP monitoring, a new motor deficit was observed in 3 of 66 patients. However, in 98 patients operated under MEP monitoring, no new motor deficit was found except for one patient who manifested delayed hemiparesis 30 h after the operation owing to a cortical vein injury during craniotomy. MEPs deteriorated in 12 patients which were related to hypotension (n=1), temporary clipping (n=7), and permanent clipping (n=4), and recovered in all after prompt corrective measures. After surgical clipping of unruptured aneurysms, the absence of new motor deficits could be reliably anticipated by recovered MEPs as well as unchanged MEPs.
Transcranial MEP monitoring is a simple, safe, and reliable tool for the prediction of postoperative motor functions. The ischemic complications can be reduced via prompt corrective measures taken on the basis of MEP changes during aneurysm surgery.
本研究旨在评估经颅运动诱发电位（MEP）监测的效用及其对未破裂颅内动脉瘤手术夹闭后发病率的影响。
比较MEP监测应用前后一年期间的运动结果。采用持续输注维库溴铵诱导并维持全静脉麻醉。通过置于C3和C4位置的皮下针电极以恒压刺激引出肌肉MEP。与基线记录相比，MEP波幅下降超过50%被视为警示信号，并及时告知外科医生。
在应用MEP监测之前，66例患者中有3例出现新的运动功能缺损。然而，在98例接受MEP监测的手术患者中，除1例患者因开颅手术期间皮质静脉损伤在术后30小时出现迟发性偏瘫外，未发现新的运动功能缺损。12例患者的MEP出现恶化，分别与低血压（n = 1）、临时夹闭（n = 7）和永久夹闭（n = 4）有关，在采取及时的纠正措施后均恢复。未破裂动脉瘤手术夹闭后，MEP恢复以及MEP未改变可可靠地预测无新的运动功能缺损。
经颅MEP监测是预测术后运动功能的一种简单、安全且可靠的工具。通过基于动脉瘤手术期间MEP变化采取及时的纠正措施，可减少缺血性并发症。
