Division of Neuroanesthesia & Intraoperative Neuromonitoring, Department of Anesthesia, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Germany.
Research & Development, inomed Medizintechnik GmbH, Im Hausgrün 29, 79312, Emmendingen, Germany.
J Clin Monit Comput. 2020 Jun;34(3):589-595. doi: 10.1007/s10877-019-00345-5. Epub 2019 Jul 2.
Monitoring of transcranial electrical motor evoked potentials (tcMEP) during carotid endarterectomy (CEA) has been shown to effectively detect intraoperative cerebral ischemia. The unique purpose of this study was to evaluate changes of MEP amplitude (AMP), area under the curve (AUC) and signal morphology (MOR) as additional MEP warning criteria for clamping-associated ischemia during CEA. Therefore, the primary outcome was the number of MEP alerts (AMP, AUC and MOR) in the patients without postoperative motor deficit (false positives). We retrospectively reviewed data from 571 patients who received CEA under general anesthesia. Monitoring of somatosensory evoked potentials (SSEP) and tcMEP was performed in all cases (all-or-none MEP warning criteria). The percentages of false positives (primary parameter) of AMP, AUC and MOR were evaluated according to the postoperative motor outcome. In the cohort of 562 patients, we found significant SSEP/MEP changes in 56 patients (9.96%). In 44 cases (7.83%) a shunt was inserted. Nine patients (1.57%) were excluded due to MEP recording failure. False positives were registered for AMP, AUC and MOR changes in 121 (24.01%), 148 (29.36%) and 165 (32.74%) patients, respectively. In combination of AMP/AUC and AMP/AUC/MOR false positives were found in 9.52% and 9.33% of the patients. This study is the first to evaluate the correctness of the MEP warning criteria AMP, AUC and MOR with regard to false positive monitoring results in the context of CEA. All additional MEP warning criteria investigated produced an unacceptably high number of false positives and therefore may not be useful in carotid surgery for adequate detection of clamping-associated ischemia.
在颈动脉内膜切除术 (CEA) 期间监测经颅电运动诱发电位 (tcMEP) 已被证明可有效检测术中脑缺血。这项研究的独特目的是评估 MEP 幅度 (AMP)、曲线下面积 (AUC) 和信号形态 (MOR) 的变化，作为 CEA 夹闭相关缺血的附加 MEP 警告标准。因此，主要结果是在没有术后运动障碍的患者中 (假阳性) 的 MEP 警报数量 (AMP、AUC 和 MOR)。我们回顾性分析了 571 例在全身麻醉下接受 CEA 的患者的数据。所有患者均进行体感诱发电位 (SEP) 和 tcMEP 监测 (MEP 全或无警告标准)。根据术后运动结果评估 AMP、AUC 和 MOR 的假阳性率 (主要参数)。在 562 例患者的队列中，我们发现 56 例患者 (9.96%) 出现明显的 SSEP/MEP 变化。在 44 例 (7.83%) 中插入了分流管。由于 MEP 记录失败，有 9 例 (1.57%) 患者被排除。AMP、AUC 和 MOR 变化分别在 121 例 (24.01%)、148 例 (29.36%) 和 165 例 (32.74%) 患者中记录到假阳性。AMP/AUC 和 AMP/AUC/MOR 假阳性在 9.52%和 9.33%的患者中发现。这项研究首次评估了在 CEA 背景下，AMP、AUC 和 MOR 等 MEP 警告标准的正确性，涉及假阳性监测结果。所有研究的附加 MEP 警告标准都产生了不可接受的大量假阳性，因此在颈动脉手术中可能无法用于充分检测夹闭相关缺血。
