Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan.
Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.
Oper Neurosurg (Hagerstown). 2021 Jul 15;21(2):E124-E125. doi: 10.1093/ons/opab113.
Despite technological advances in endovascular therapy, surgical clipping of paraclinoid aneurysms remains an indispensable treatment option and has an acceptable profile risk. Intraoperative monitoring of motor and somatosensory evoked potentials has proven to be an effective tool in predicting and preventing postoperative motor deficits during aneurysm clipping.1,2 We describe the case of a 61-yr-old Japanese woman with a history of hypertension and smoking. During follow-up for bilateral aneurysms of ophthalmic segment of the internal carotid artery (ICA), left-sided aneurysm growth was detected. A standard pterional approach with extradural clinoidectomy was used to approach the aneurysm. After clipping, a significant intraprocedural change in motor evoked potential (MEP) amplitude was observed despite native vessel patency was confirmed through micro-Doppler and indocyanine green video angiography.3-5 After extensive dissection of the sylvian fissure and exposure of the communicating segment of ICA, the anterior choroidal artery was found to be compressed and occluded by the posterior clinoid because of an inadvertent shift of the ICA after clip application and removal of brain retractors. Posterior clinoidectomy was performed intradurally with microrongeur and MEP amplitude returned readily to baseline values. Computed tomography (CT) angiogram demonstrated complete exclusion of the aneurysm, and magnetic resonance imaging (MRI) was negative for postoperative ischemic lesions on diffusion weighted images. The patient tolerated the procedure well and was discharged home on postoperative day 3 with modified Rankin Scale (mRS) 0. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
尽管血管内治疗技术取得了进步，但外科夹闭颅底旁动脉瘤仍然是一种不可或缺的治疗选择，并且具有可接受的风险特征。术中监测运动和体感诱发电位已被证明是一种有效的工具，可以预测和防止动脉瘤夹闭术后运动功能障碍。1,2 我们描述了一位 61 岁日本女性的病例，她有高血压和吸烟史。在双侧颈内动脉眼段动脉瘤的随访中，发现左侧动脉瘤增大。采用标准翼点入路和硬膜外岩骨切除术来接近动脉瘤。夹闭后，尽管通过微多普勒和吲哚菁绿视频血管造影证实了载瘤血管通畅，但运动诱发电位（MEP）振幅出现了显著的术中变化。3-5 在广泛分离侧裂并暴露颈内动脉交通段后，发现由于夹闭应用和脑牵开器去除后颈内动脉位置的意外移位，后交通动脉被压迫和闭塞。在硬脑膜内使用微型咬骨钳进行后床突切除术，MEP 振幅很快恢复到基线值。计算机断层扫描（CT）血管造影显示动脉瘤完全被排除，磁共振成像（MRI）在弥散加权图像上未见术后缺血性病变。患者术后恢复良好，于术后第 3 天出院，改良 Rankin 量表（mRS）评分为 0。患者签署了机构同意书，同意接受手术，并允许将其图像和视频用于任何类型的医学出版物。
