Drenckhahn Christoph, Windler Claudia, Major Sebastian, Kang Eun-Jeung, Scheel Michael, Vajkoczy Peter, Hartings Jed A, Woitzik Johannes, Dreier Jens P
*Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany; Departments of †Neurology, ‡Experimental Neurology, §Neuroradiology, and ‖Neurosurgery, Charité University Medicine Berlin, Berlin, Germany; ¶Department of Neurosurgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio, U.S.A.; and #Mayfield Clinic, Cincinnati, Ohio, U.S.A.
J Clin Neurophysiol. 2016 Jun;33(3):250-9. doi: 10.1097/WNP.0000000000000274.
Patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently develop secondary noninfectious and infectious complications with an important impact on clinical course and outcome. In this study, we report on the rate of typical extracranial and intracranial complications in 30 prospectively enrolled patients with severe aSAH who received a linear subdural recording strip for continuous electrocorticography to detect ictal epileptiform events and spreading depolarizations.
The group was compared with 30 retrospectively included patients with aSAH who had not received a subdural recording strip, but were treated during the same period. The control group was matched according to an aSAH grading system, sex, and establishment of external ventricular drainage, but could not be matched according to aneurysm treatment and focal brain lesions such as initial intracerebral hemorrhages.
No evidence was found that procedures of the electrocorticography study led to clinically relevant complications. In particular, the subdural strip did not lead to local damage of brain tissue or any increased rate of meningitis/ventriculitis. The median score on the modified Rankin Scale on day 15 was the same in both groups. Minor differences between both groups are explained by the limitations in the study design.
Our study suggests that neuromonitoring with a subdural recording strip for up to 15 days can be safely performed in patients with aSAH.
动脉瘤性蛛网膜下腔出血（aSAH）患者常出现继发性非感染性和感染性并发症，对临床病程和预后有重要影响。在本研究中，我们报告了30例前瞻性纳入的重度aSAH患者典型颅外和颅内并发症的发生率，这些患者接受了线性硬膜下记录条以进行连续皮层脑电图检查，以检测发作期癫痫样事件和扩散性去极化。
将该组患者与30例回顾性纳入的aSAH患者进行比较，这些患者未接受硬膜下记录条，但在同一时期接受了治疗。对照组根据aSAH分级系统、性别和外部脑室引流的建立进行匹配，但不能根据动脉瘤治疗和局灶性脑病变（如初始脑出血）进行匹配。
未发现皮层脑电图研究程序导致临床相关并发症的证据。特别是，硬膜下记录条未导致脑组织局部损伤或任何脑膜炎/脑室炎发生率的增加。两组在第15天的改良Rankin量表中位数评分相同。两组之间的微小差异可由研究设计的局限性来解释。
我们的研究表明，aSAH患者可安全地进行长达15天的硬膜下记录条神经监测。
