Bican Orhan, Cho Charles, Suarez-Roman Areli, Nguyen Viet, Lee Leslie, Le Scheherazade, Heit Jeremy, Dodd Robert, López Jaime
Stanford University, Department of Neurology, 300 Pasteur Drive, Stanford 94305, CA, United States; University of Utah, Department of Neurology, 175 N Medical Drive, Salt Lake City 84132, UT, United States.
Stanford University, Department of Neurology, 300 Pasteur Drive, Stanford 94305, CA, United States.
J Clin Neurosci. 2019 May;63:68-71. doi: 10.1016/j.jocn.2019.01.051. Epub 2019 Feb 14.
Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients. BAEPs were performed in anesthetized patients if indicated. Methohexital was administered as an injection at a dose of 5 mg or 10 mg and repeat testing was performed if needed.Sixty-three endovascular procedures that met criteria were performed in 32 patients. 54 procedures in 28 patients were performed under general anesthesia, 9 procedures in 4 patients were performed in wakefulness. PT was negative in 61 procedures and subsequently completed embolizations without neurological sequelae. In two cases, the testing was positive and the procedure was terminated without embolization in one patient. The other patient underwent embolization at an alternative site without repeat PT. There were no new postoperative neurologic deficits after any of these procedures. Specificity of PT was 100% as none of the patients with a negative provocative test developed a new postoperative neurologic deficit after embolization. To our knowledge, this is the first review of PT with the use of neurophysiologic IONM techniques under general anesthesia. These data suggest a high specificity comparable to awake testing.
药理激发试验（PT）和术中神经生理监测（IONM）均可减轻并预测与血管内栓塞手术相关的风险。我们介绍了一系列主要因动静脉畸形（AVM）接受血管内颅内栓塞的患者，这些手术分别在全身麻醉和清醒状态下进行，并使用了IONM。我们回顾了数据库，以确定2014年1月1日至2016年1月1日期间所有接受血管内手术的患者。清醒患者接受了体感诱发电位（SSEP）、脑电图（EEG）和实时神经学检查，而所有麻醉患者均进行了经颅运动诱发电位（TcMEP）检查。如有指征，对麻醉患者进行脑干听觉诱发电位（BAEP）检查。美索比妥以5毫克或10毫克的剂量注射给药，如有需要则进行重复检查。32例患者共进行了63例符合标准的血管内手术。28例患者的54例手术在全身麻醉下进行，4例患者的9例手术在清醒状态下进行。61例手术的PT结果为阴性，随后完成栓塞且无神经后遗症。在两例病例中，检查结果为阳性，其中一例患者未进行栓塞即终止了手术。另一例患者在另一个部位进行了栓塞，未重复PT检查。这些手术之后均未出现新的术后神经功能缺损。PT的特异性为100%，因为激发试验结果为阴性的患者在栓塞后均未出现新的术后神经功能缺损。据我们所知，这是首次在全身麻醉下使用神经生理IONM技术对PT进行的综述。这些数据表明其特异性与清醒检查相当。
