Hacke W, Hündgen R, Zeumer H, Ferbert A, Buchner H
EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb. 1985 Jun;16(2):93-100.
Interventional neuroradiology makes use of different diagnostic and therapeutic catheterization techniques. Treatments performed are local intraarterial thrombolytic therapy, embolization and occlusion of brain supplying arteries, percutaneous transluminal angioplasty and intraarterial application of drugs. These treatments make it most important to check the patients neurological state during the procedure. Intraoperative monitoring of evoked potentials offers the opportunity to get objective information about changes in certain central nervous system functions even in anaesthesized patients. Usually intraoperative monitoring is performed to obtain information whether the function of structures at risk remains stable or is altered by the operation. This represents a more passive, observing way of monitoring. During interventional neuroradiology one is enabled to take additionally a more active and experimental way of monitoring by using the advantages of special catheter techniques like series of reversible balloon occlusion or intraarterial drug application. This leads to a dialogue between the radiologist and the neurophysiologist about the safety or the risk of the next step during a procedure. There are mainly two types of new information that can be achieved by active monitoring: the identification of functional territories of single or multiple feeding vessels and new insights into hemodynamics and the establishing of new sufficient collaterals. We have used intraoperative neuromonitoring in 35 patients during interventional neuroradiology. Our findings will be summarized and the usefulness of the different monitoring methods will be discussed.
介入神经放射学利用不同的诊断和治疗性导管插入技术。所进行的治疗包括局部动脉内溶栓治疗、脑供血动脉的栓塞和闭塞、经皮腔内血管成形术以及动脉内药物应用。这些治疗使得在操作过程中检查患者的神经状态变得至关重要。术中诱发电位监测为获取关于某些中枢神经系统功能变化的客观信息提供了机会，即使是在麻醉患者中也是如此。通常进行术中监测是为了获取有关处于风险中的结构功能是否保持稳定或是否因手术而改变的信息。这代表了一种更被动的观察性监测方式。在介入神经放射学过程中，通过利用特殊导管技术（如一系列可逆性球囊闭塞或动脉内药物应用）的优势，还能够采取更主动和实验性的监测方式。这导致放射科医生和神经生理学家之间就操作过程中下一步的安全性或风险进行对话。通过主动监测主要可以获得两种新信息：识别单支或多支供血血管的功能区域以及对血流动力学的新见解和建立新的充分侧支循环。我们在35例介入神经放射学患者中使用了术中神经监测。我们将总结我们的发现并讨论不同监测方法的实用性。
