Paiva T, Campos J, Baeta E, Gomes L B, Martins I P, Parreira E
Lab. EEG, Centro de Estudos Egas Moniz, Neurology, Hospital de Santa Maria, Lisbon, Portugal.
Electroencephalogr Clin Neurophysiol. 1995 Jul;95(1):3-13. doi: 10.1016/0013-4694(95)00016-r.
Arteriovenous malformations (AVMs) may have a bad prognosis. Endovascular embolization with cyanocrylate represents nowadays an important initial step in a staged treatment, that later may include surgery or radiotherapy. Embolization may induce significant changes in the dynamics of the cerebral circulation, some of which may provoke neurological sequelae. Therefore assessment of potential complications is usually done by using a superselective amytal test, during which small doses of amytal are injected directly in the pedicle that is going to be embolized. In spite of an extensive use of the EEG during endovascular embolization its evaluation in terms of benefits and limitations is not available. Such evaluation is therefore the aim of this work. EEG monitoring was performed during endovascular embolization of 19 patients; a large majority of patients presented large AVMs, with Spetzler indexes around IV or V. The main results were as follows: (1) EEG changes at baseline were significantly correlated with the AVM size and the Spetzler index but were unable to predict the difficulties in the embolization; (2) during amytal tests EEG positivity reached 35% and consisted mainly in ipsilateral slow focal activity; (3) in some cases embolization was performed in spite of transient EEG changes. It was found that focal or diffuse abnormalities in the lower frequency range, even when slight, could be followed by clinical hazards (3 out of 11 cases); (4) EEG monitoring was important in the prediction, evaluation and prognosis of clinical complications.
动静脉畸形（AVM）可能预后不良。如今，使用氰基丙烯酸酯进行血管内栓塞是分期治疗的重要初始步骤，后续可能包括手术或放疗。栓塞可能会引起脑循环动力学的显著变化，其中一些变化可能会引发神经后遗症。因此，通常通过超选择性阿米妥试验来评估潜在并发症，在此试验过程中，将小剂量的阿米妥直接注入即将被栓塞的蒂部。尽管在血管内栓塞过程中广泛使用脑电图（EEG），但关于其益处和局限性的评估尚未可得。因此，本研究的目的就是进行这样的评估。对19例患者进行了血管内栓塞期间的EEG监测；绝大多数患者患有大型AVM，斯佩茨勒指数约为IV或V级。主要结果如下：（1）基线时的EEG变化与AVM大小和斯佩茨勒指数显著相关，但无法预测栓塞的难度；（2）在阿米妥试验期间，EEG阳性率达到35%，主要表现为同侧局灶性慢波活动；（3）在某些情况下，尽管EEG出现短暂变化仍进行了栓塞。结果发现，低频范围内的局灶性或弥漫性异常，即使很轻微，也可能伴有临床风险（11例中有3例）；（4）EEG监测在临床并发症的预测、评估和预后方面很重要。
