Byoun Hyoung Soo, Oh Chang Wan, Kwon O-Ki, Lee Si Un, Ban Seung Pil, Kim Sung Hoon, Kim Tackeun, Bang Jae Seung, Kim Sung Un, Choi Jongsuk, Park Kyung Seok
Department of Neurosurgery, Chungnam National University Hospital, Daejeon, South Korea.
Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Clin Neurol Neurosurg. 2019 Nov;186:105503. doi: 10.1016/j.clineuro.2019.105503. Epub 2019 Aug 27.
To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm.
From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated.
Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972-1.000), PPVs; 100% (95% CI = 0.055-1.000), and NPVs; 93% (95% CI = 0.945-0.973) with low sensitivity; 11.1% (95% CI = 0.006-0.111) were calculated.
IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.
探讨术中神经监测（IONM），包括体感诱发电位（SSEP）和运动诱发电位（MEP）在未破裂脉络膜前动脉（AChA）动脉瘤显微夹闭术中的安全性及意外发现。
回顾性分析2011年1月至2018年3月期间115例在IONM监测下行未破裂AChA动脉瘤显微夹闭术患者的神经生理学、临床及影像学资料。计算未破裂AChA动脉瘤显微夹闭术后缺血性并发症的发生率，以及术中IONM的假阴性率、灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。
115例患者中，7例（6.08%）在IONM监测下行AChA动脉瘤显微夹闭术后出现缺血性并发症。其中3例有症状（2.6%）。IONM对缺血性并发症的假阴性率为6.08%（7例）。计算得出特异度高；100%（95%置信区间[95%CI] = 0.972 - 1.000），PPV为100%（95%CI = 0.055 - 1.000），NPV为93%（95%CI = 0.945 - 0.973），而灵敏度低；11.1%（95%CI = 0.006 - 0.111）。
在未破裂AChA动脉瘤显微夹闭术中，包括经颅MEP的IONM可能作用有限。因此，应考虑采用其他使用直接皮层刺激或改良经颅方法的MEP监测来进行补充。
