Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka, Japan.
J Neurosurg Anesthesiol. 2010 Jul;22(3):247-51. doi: 10.1097/ANA.0b013e3181de4eae.
Surgical clipping may cause stenosis of parent arteries or occlusion of perforating arteries in cerebral aneurysm surgery. To prevent postoperative motor deficits, motor-evoked potentials (MEPs) have been used. This enables to detect cerebral ischemia. However, the rate of false negatives (motor deficits with preserved MEP) has been relatively higher than in aortic surgery. We hypothesized that postoperative motor deficits with preserved intraoperative MEP do not always represent false negatives. We reviewed medical records of patients for cerebral aneurysms surgery with transcranial MEP monitoring from September 2003 to March 2009. We reviewed aneurysm location and size, abnormal computed tomography findings, and clinical outcome. Motor status was evaluated immediately after extubation and anytime when the symptom of motor deficits was found. One hundred and eleven patients underwent cerebral aneurysm clipping with transcranial MEP. Ninety-eight patients manifested no intraoperative MEP changes and no postoperative motor deficits. Six patients showed intraoperative MEP changes, resulting in no motor deficits in 4 patients with MEP recovery and hemiparesis in 2 without MEP recovery. Four patients of 6 had aneurysm in anterior choroidal artery (AchA). Other 6 patients showed postoperative motor deficits despite preserved intraoperative MEP. Two of 6 patients showed no motor deficits just after extubation, but developed deficits 5 hours after coming out of anesthesia. Only 1 of the 6 patients had aneurysm in AchA. In AchA aneurysm surgery, intraoperative MEP monitoring seems to be useful. False negative in MEP monitoring may include new-onset hemiparesis despite preserved intraoperative MEP.
在脑动脉瘤手术中，外科夹闭可能导致母动脉狭窄或穿支动脉闭塞。为了防止术后运动功能障碍，运动诱发电位（MEP）被用于检测脑缺血。然而，假阴性（保留 MEP 的运动功能障碍）的发生率相对高于主动脉手术。我们假设保留术中 MEP 的术后运动功能障碍并不总是代表假阴性。我们回顾了 2003 年 9 月至 2009 年 3 月期间接受经颅 MEP 监测的脑动脉瘤手术患者的病历。我们回顾了动脉瘤的位置和大小、异常 CT 发现和临床结果。在拔管后和发现运动功能障碍症状时立即评估运动状态。111 例患者接受了经颅 MEP 监测的脑动脉瘤夹闭术。98 例患者术中 MEP 无变化，术后无运动功能障碍。6 例患者出现术中 MEP 变化，其中 4 例 MEP 恢复，无运动功能障碍，2 例 MEP 未恢复，出现偏瘫。4 例患者的动脉瘤位于前交通动脉（AchA）。其他 6 例患者尽管保留了术中 MEP，但仍出现术后运动功能障碍。6 例患者中有 2 例拔管后即刻无运动功能障碍，但麻醉后 5 小时出现运动功能障碍。只有 1 例患者的动脉瘤位于 AchA。在 AchA 动脉瘤手术中，术中 MEP 监测似乎是有用的。尽管保留了术中 MEP，但 MEP 监测中的假阴性可能包括新出现的偏瘫。
