De Vleeschauwer P, Horsch S, Matamoros R
Surgical Department, Akademisches Lehrkrankenhaus, Cologne, West Germany.
Ann Vasc Surg. 1988 Jan;2(1):63-8. doi: 10.1016/S0890-5096(06)60779-6.
We have monitored cortical somatosensory evoked potentials (SEP) during 177 carotid operations (167 carotid endarterectomies). An intraluminal shunt was always used for endarterectomy of the internal carotid artery (CEA). SEP was not readable in 21 operations. During 126 carotid operations, no alteration of SEP occurred. However, three patients had an immediate postoperative neurologic deficit while the SEP remained normal. Abnormal SEP occurred in 30 patients. In two cases irreversible loss of SEP was seen. Both patients awoke with a new neurologic deficit after the operation. We found reversible abnormal SEP in 28 cases. In 63 cases with contralateral stenosis, abnormal SEP caused by carotid clamping was observed in 15 (24%). The diagnostic sensitivity of intraoperative SEP monitoring in predicting neurologic outcome following carotid operation was 100% with a specificity of 40%. Monitoring of SEP during carotid surgery is a reliable and useful method to detect incipient cerebral ischemia and to determine the need for shunting. The prognostic value of SEP monitoring to predict postoperative neurologic deficits is limited by the low specificity of the method.
我们在177例颈动脉手术（167例颈动脉内膜切除术）中监测了皮质体感诱发电位（SEP）。在颈内动脉内膜切除术（CEA）中始终使用腔内分流术。21例手术中SEP无法读取。在126例颈动脉手术中，SEP未发生改变。然而，3例患者术后立即出现神经功能缺损，而SEP仍保持正常。30例患者出现SEP异常。2例出现SEP不可逆丧失。两名患者术后苏醒时均出现新的神经功能缺损。我们发现28例SEP可逆异常。在63例对侧狭窄病例中，15例（24%）在颈动脉夹闭时观察到由其导致的SEP异常。术中SEP监测对颈动脉手术后神经功能结局的诊断敏感性为100%，特异性为40%。颈动脉手术期间的SEP监测是检测早期脑缺血和确定是否需要分流的可靠且有用的方法。SEP监测对预测术后神经功能缺损的预后价值受到该方法低特异性的限制。
