Jones T H, Chiappa K H, Young R R, Ojemann R G, Crowell R M
Stroke. 1979 May-Jun;10(3):292-4. doi: 10.1161/01.str.10.3.292.
EEG was monitored at bilateral scalp sites outside the operative field during hypotensive aneurysm surgery in 21 patients. Mean arterial blood pressure at axillary level was 50-60 mm Hg (average 55 mm) for 1.9-5.3 hours (average 3.6). Four new deficits were noted immediately post-operatively, all related to the operated site: these were attributable to intra-operative rupture with forced vascular clipping, vasospasm, or edema. In no instance was hypotension solely responsible for a new deficit. EEG showed persistent slowing in relation to surgery in only 1 patient, where aneurysmal rupture led to severe hypotension, forced clipping of 1 posterior cerebral artery, and subsequent brain stem infarction. In the 3 other patients with fresh focal postoperative deficits, no persistent intraoperative EEG changes were observed. EEG monitoring did not detect ischemia in these 3 patients because 1) hypotension was moderate and did not per se cause new deficit, and 2) EEG electrodes did not survey the area at maximal risk, namely the operative field. EEG scalp electrodes near but outside the operative site do not seem useful for monitoring cerebral function in the region of aneurysm surgery. Epidural or cortical electrodes in the operative field may prove to be more useful.
在21例患者的降压性动脉瘤手术过程中，在手术区域外的双侧头皮部位监测脑电图（EEG）。腋窝水平的平均动脉血压在50 - 60毫米汞柱（平均55毫米汞柱），持续1.9 - 5.3小时（平均3.6小时）。术后立即发现4例新的神经功能缺损，均与手术部位有关：这些是由于术中破裂伴强行血管夹闭、血管痉挛或水肿所致。低血压从未单独导致新的神经功能缺损。仅1例患者的脑电图显示与手术相关的持续减慢，该患者动脉瘤破裂导致严重低血压、一侧大脑后动脉强行夹闭及随后的脑干梗死。在另外3例有新的术后局灶性神经功能缺损的患者中，未观察到术中脑电图的持续变化。脑电图监测未在这3例患者中检测到缺血，原因如下：1）低血压程度较轻，本身未导致新的神经功能缺损；2）脑电图电极未覆盖最大风险区域，即手术区域。手术部位附近但在手术区域外的头皮脑电图电极似乎对动脉瘤手术区域的脑功能监测无用。手术区域的硬膜外或皮质电极可能更有用。
