Park Dougho, Kim Byung Hee, Lee Sang-Eok, Jeong Eunhwan, Cho Kwansang, Park Ji Kang, Choi Yeon-Ju, Jin Suntak, Hong Daeyoung, Kim Mun-Chul
Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.
Department of Neurology, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.
Front Surg. 2021 Feb 26;8:631053. doi: 10.3389/fsurg.2021.631053. eCollection 2021.
Intraoperative neurophysiological monitoring (IONM) has been widely applied in brain vascular surgeries to reduce postoperative neurologic deficit (PND). This study aimed to investigate the effect of IONM during clipping of unruptured intracranial aneurysms (UIAs). Between January 2013 and August 2020, we enrolled 193 patients with 202 UIAs in the N group (clipping without IONM) and 319 patients with 343 UIAs in the M group (clipping with IONM). Patients in the M group were intraoperatively monitored for motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs). Irreversible evoked potential (EP) change was defined as EP deterioration that did not recover until surgery completion. Sustained PND was defined as neurological symptoms lasting for more than one postoperative month. Ten (3.1%) and 13 (6.7%) in the M and N groups, respectively, presented with PND. Compared with the N group, the M group had significantly lower occurrence rates of sustained PND [odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.13-0.98, = 0.04], ischemic complications (OR = 0.39, 95% CI = 0.15-0.98, = 0.04), and radiologic complications (OR = 0.40, 95% CI = 0.19-0.82, = 0.01). Temporary clipping was an independent risk factor for ischemic complications (ICs) in the total patient group (OR = 6.18, 95% CI = 1.75-21.83, = 0.005), but not in the M group (OR = 5.53, 95% CI = 0.76-41.92, = 0.09). Regarding PND prediction, considering any EP changes (MEP and/or SSEP) showed the best diagnostic efficiency with a sensitivity of 0.900, specificity of 0.940, positive predictive value of 0.321, negative predictive value (NPV) of 0.997, and a negative likelihood ratio (LR) of 0.11. IONM application during UIA clipping can reduce PND and radiological complications. The diagnostic effectiveness of IONM, specifically the NPV and LR negative values, was optimal upon consideration of changes in any EP modality.
术中神经生理监测（IONM）已广泛应用于脑血管手术，以减少术后神经功能缺损（PND）。本研究旨在探讨IONM在未破裂颅内动脉瘤（UIA）夹闭术中的作用。2013年1月至2020年8月，我们纳入了N组（未行IONM夹闭术）的193例患者共202个UIA，以及M组（行IONM夹闭术）的319例患者共343个UIA。M组患者术中监测运动诱发电位（MEP）和体感诱发电位（SSEP）。不可逆诱发电位（EP）变化定义为直至手术结束仍未恢复的EP恶化。持续性PND定义为术后持续一个月以上的神经症状。M组和N组分别有10例（3.1%）和13例（6.7%）出现PND。与N组相比，M组持续性PND的发生率显著降低[比值比（OR）=0.36，95%置信区间（CI）=0.13 - 0.98，P = 0.04]，缺血性并发症（OR = 0.39，95%CI = 0.15 - 0.98，P = 0.04）和影像学并发症（OR = 0.40，95%CI = 0.19 - 0.82，P = 0.01）。临时夹闭是全患者组缺血性并发症（ICs）的独立危险因素（OR = 6.18，95%CI = 1.75 - 21.83，P = 0.005），但在M组中不是（OR = 5.53，95%CI = 0.76 - 41.92，P = 0.09）。关于PND预测，考虑任何EP变化（MEP和/或SSEP）显示出最佳诊断效率，敏感性为0.900，特异性为0.940，阳性预测值为0.321，阴性预测值（NPV）为0.997，阴性似然比（LR）为0.11。在UIA夹闭术中应用IONM可减少PND和影像学并发症。IONM的诊断有效性，特别是NPV和LR阴性值，在考虑任何EP模式变化时最佳。
