Huguenard Anna L, Guerriero Rejean M, Tomko Stuart R, Limbrick David D, Zipfel Gregory J, Guilliams Kristin P, Strahle Jennifer M
Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri.
Division of Pediatric and Developmental Neurology, Department of Neurology, St. Louis Children's Hospital, St. Louis, Missouri.
Pediatr Neurol. 2021 May;118:40-45. doi: 10.1016/j.pediatrneurol.2021.02.004. Epub 2021 Feb 15.
Moyamoya disease and syndrome are progressive steno-occlusive cerebrovascular diseases that manifest clinically with ischemic episodes. There is evidence for the use of electroencephalography (EEG) in preoperative and long-term postoperative evaluation of these patients, as well as in the intraoperative period to monitor for changes correlated with perioperative ischemic events. However, the utility of EEG in the immediate postprocedure time period has not previously been described.
We review six patients who underwent pial synangiosis from 2017 to 2019. EEGs from the preoperative, intraoperative, and immediate postoperative period were evaluated, as well as clinical examination changes and subsequent interventions.
Six patients with postoperative EEG monitoring following pial synangiosis were included. EEG data was collected preoperatively, intraoperatively, and continuously postoperatively. Preoperatively, five of six patients had normal background activity on EEG, whereas one of six had hemispheric asymmetry. Three patients had new or worsening hemispheric intracerebral asymmetry on EEG during the immediate postsurgical period. Two of these had no clinical manifestations of ischemia, and one had transient left facial weakness. All three underwent blood pressure augmentation with improvement in the asymmetry on EEG and clinical improvement in the symptomatic patient.
Although widely accepted as a useful tool during the preoperative and intraoperative periods of evaluation and management of moyamoya disease and syndrome, we propose that the use of continuous EEG in the immediate postoperative period may have potential as a useful adjunct by both detecting early clinical and subclinical intracranial ischemia.
烟雾病和烟雾综合征是进行性狭窄闭塞性脑血管疾病，临床上表现为缺血发作。有证据表明，脑电图（EEG）可用于这些患者的术前和长期术后评估，以及在手术期间监测与围手术期缺血事件相关的变化。然而，EEG在术后即刻时间段的效用此前尚未见报道。
我们回顾了2017年至2019年接受软脑膜血管吻合术的6例患者。对术前、术中及术后即刻的EEG进行评估，并观察临床检查变化及后续干预措施。
纳入6例软脑膜血管吻合术后进行EEG监测的患者。术前、术中及术后持续收集EEG数据。术前，6例患者中有5例EEG背景活动正常，而6例中有1例存在半球不对称。3例患者在术后即刻EEG出现新的或加重的半球内脑不对称。其中2例无缺血临床表现，1例有短暂性左侧面部无力。所有3例均进行了血压升高治疗，EEG不对称性改善，有症状的患者临床症状也得到改善。
尽管EEG在烟雾病和烟雾综合征的术前和术中评估及管理期间被广泛认为是一种有用的工具，但我们认为术后即刻连续使用EEG可能具有潜在作用，可通过检测早期临床和亚临床颅内缺血作为一种有用的辅助手段。
