Effect Of Neuroelectrophysiological Monitoring In Endovascular Embolization Of Intracranial Aneurysms

Objective:To investigate the applied value of multimodal combined neuroelectrophysiological monitoring in endovascular embolization of intracranial aneurysms.Methods:A retrospective analysis from May 2013 to June 2014 we treated 44 patients of intracranial anterior circulation aneurysm with endovascular embolization. 44 patients were divided into two groups according to whether use intraoperative electrophysiological monitoring, the first group with 21 patients without electrophysiological monitoring in May 2013 to November 2013(referred to as non monitoring group) and the second group with 23 patients with electrophysiological monitoring in December 2013 to June 2014(referred to as the monitoring group). Used the intraoperative evoked potential monitoring system America Cadwell Cascade 32-lead, according to the international standard EEG 10/20, placed electrodes and set parameter.Somatosensory evoked potential(SEP)、motion evoked potential(MEP)、scalp electroencephalogram(Scalp EEG) and brainstem auditory evoked potential(BAEP) were monitored during operation according to the position of intracranial aneurysm and its associated vascular territory. Various monitoring waveform baseline were set when the guide tube was arranged, observed the changes of electrophysiological index intraoperative.CT scan was onventional after operation.As long as there were a level of consciousness and language function decline,or any limb muscle strength and sensory function were decreased compared with preoperative in patients at the first day postoperative, that was considered to appear new nerve impairment. Assessed prognosis according to the Glasgow Outcome Scale(GOS) score 3 months after discharge(5 points is considered as a good recovery). Postoperative new nerve impairment and prognosis( good prognosis, disability, death) at the three month after leaving hospital of two groups were compared statistically.Results:(1)Compared the general informations of two group patients, age, gender, preoperative Hunt-Hess classification, the size 、 location and the number of aneurysm,were all not statistically significant difference(P>0.05).The two groups were comparable.(2)Comparing the monitoring group with the non- monitoring group,the numbers of patients with postoperative new nerve impairment was statistically significant differences(P=0.032,<0.05), the rates of good prognosis and disability were statistics difference(P=0.027,<0.05), The two groups were no death case.(3)In the monitoring group 23 patients,there were 6 cases of single SEP monitoring, 5 cases of SEP combined with MEP monitoring, 8 cases of SEP combined with scalp EEG, 1 cases of SEP combined with BAEP monitoring, 3 cases of combined application of SEP, MEP and scalp EEG monitoring modes.The intraoperative electrophysiological index were not abnormal changed in 13 cases of patients.there were no new neurological dysfunction after operation.10 cases of patients appeared abnormal changes of intraoperative electrophysiological index, and 4 cases of patients occured new neurological dysfunction after operation.In the monitoring group,SEP changes were observed in 9 patients,MEP changes in 3 patients,Scalp EEG changes in 4 patients, Cerebral ischemia was detected in 9 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately,such as: papaverine spasmolysis,suspended the endovascular operation,adjusted the position of stent, withdraw the last coil before releasing detachable coil. Before the end of operation,electrophysiological waveforms were completely recovered in 3 cases of patients,not completely recovered in 6 cases of patients. There was 1 patient, in the monitoring process,SEP monitoring was normal,but MEP of the right upper arm wasfailed to elicit, and appeared new neurological dysfunction after operation.Conclusions:Multimodal combined neuroelectrophysiological monitoring could improve the sensitivity of intraoperative cerebral ischemia, reduce the risk of cerebral ischemia and enhance treatment security in intracranial aneurysm embolization.