| Background and objectiveIntracranial aneurysm is one of common cerebrovascular disease, which causes human death, disability. As the development of modern video, endoscopic technology,microsurgical, unceasing surgical instrument updates, neurosurgery minimally invasive surgery had great progress, intracranial aneurysms rates are improved obviously. But the surgery still exists many postoperative complications and could easily cause corresponding regional brain tissue injury and cerebral ischemia, and eventually cause nerve function defect, postoperative may produce hemiplegia and severe complications. Therefore, how to further improve brain aneurysms particularly intractable brain aneurysms surgical treatment effect of domestic and foreign neurosurgery world becomes an important research topic. Intraoperative neural electrophysiology monitoring technology of the cerebral cortex function and (or) the integrity of the variety of neural pathways, continuous real-time monitoring and evaluation, from electrophysiological Angle monitoring of the brain function, understand lesions removed degree, predict or early detection of possible brain ischemia and corrected, and even the correction operation program, which avoid the intraoperative iatrogenic lesions, further improve the effect and reduce morbidity.Methods68 cases of patients with intracranial aneurysms by microsurgery for aneurysm clipping from 2009 March to 2010 september. both Somatosensory Evoked Potential (SSEPs),Motor Evoked Potential, Somatosensory Evoked Potential (SSEP) ssports, Evoked potentials (which all Evoked, MEPs(MEPs),Brainstem Auditory Evoked potential(BAEPs) 3 items could be elicited.Through analysis of intraoperatie EPs joint monitoring neural function monitoring, understand the sensitivity and specificity operation process, whether cerebral ischemia and the influence of neurological function in patients with intraoperative monitoring results, and postoperative neurological prospective observational study, analysis for intraoperative EPs joint monitoring in the clinical value of intracranial aneurysm.Results1,SSEPs,MEPs,BAEPs could be elicited in 66 of 68 patinets(92.6%), none of them did not appear evoked potential monitoring result of complications.2,There is no electrophysiology signal abnormal changes in 56 patinets,2 of them don't exit permanent nerve dysfunction but Temporary muscle weakness.3,There are obvious electrophysiology signal abnormal changes in 10 patinets:five cases were abnormal of EPs,one case was abnormal of SSEPs and MEPs, one case was abnormal of SSEPs and BAEPs,only one case was abnormal of MEPs.4 After take corresponding measures to intervene, electrophysiology signal back to normal after the six patients does not appear new hair permanent nerve dysfunction, the other 4 cases not restore or not fully recover after a 1.7-fold all appear new nerve dysfunction, including 1 cases in postoperative 1 month,3 cases appears permanent recovery movement function obstacle.Conclusion1,SSEPs,MEPs,BAEPs could be elicited in 66 of 68 patinets(92.6%), none of them did not appear evoked potential monitoring result of complications.2,Monitoring of SSEPs,MEPs or BAEPs all can predict or early found that cerebral ischemic.3,Combined monitoring of SSEPs, MEPs and BAEPs can reduce false negative rate, effectively improve the sensitivity and results of monitoring the reliability;4,Combined monitoring of EPs can be obtained earlier evidence of cerebral ischemia, timely correction operation program to avoid intraoperative iatrogenic damage, judge correction scheme effect according to its recovery degree preliminary judgment correction scheme effect.5,there is consistency of combined monitoring of EPs,postoperative imaging check,neural function situationy, which can effectively reduce the complications and morbidity, improve the safety of the procedure and curative effect, eventually improve the quality of life of patients... |
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