Application Of Intraoperative Neuroelectrophysiological Monitoring Technique In Clipping Intracranial Aneurysms

Objective : To investigate the application value of intraoperative neu-roelectrophysiological monitoring technique in clipping intracranial aneur-ysms.Methods:Retrospective analysis of patients with intracranial aneurysm clipping treated in our department from May 2016 to January 2018,46 patients’ data were collected in accordance with the inclusion and exclusion criteria.The patients assessed by Hunt-Hess scale,Glasgow coma scale(GCS),The World Federation of Neurological Surgeons scale for subarachnoid hemorrhage(WFNS scale)and Prognosis on admission of aneurysmal sub-arachnoid hemorrhage scale(PAASH scale).CT scans of patients is classifying according to Fisher scale.Use Cadwell Cascade Pro intrao-perative electrophysiological monitor and electrode placement in 10-20 EEG international system during operation to joint monitor of somatosensory evoked potentials(SEP),motor evoked potentials(MEP)and scalp electroencephalogram(Scalp EEG).Descriptive analysis was made of the specific conditions of operation during SEP,MEP and Scalp EEG waveform alarm during operation,interventions based on intrao-perative IONM abnormalities,waveform recovery after intervention,and prognosis of patients discharged from hospital by using modified Rankin scale(mRS scale)and Glasgow outcome scale(GOS scale)to investigate the application value of intraoperative neuroelectrophysiological monitoring technique in clipping intracranial aneurysms.Results:Evoked potentials could be elicited in 45 of 46 patients at first time(95.7%).22 patients occurred IONM alarm at least one time during operation(47.8%),12 of them were alerted by SEP(54.4%),7 of them were alerted by MEP(31.8%),11 of them were alerted by Scalp EEG(50%).Among the 22 patients with IONM alarm,12 were caused by temporary blocking of parent artery,2 were caused by over-traction of brain tissue,2 were caused by excessive clamping,1 was caused by intra-operative rupture of aneurysm requiring vascular bypass,and 3 were caused by anesthetic factors.After intervention,IONM recovered in 18 patients,but new neurological dysfunction occurred in 6 patients after operation(27.3%).Among 24 patients without IONM alarm,3 patients developed new neurological dysfunction after operation.None of the 46 patients had any adverse reactions due to IONM.Conclusion:Intraoperative neuroelectrophysiological monitoring technique can safely and effectively reduce the complications of intracranial aneurysm clipping,ensure the safety of surgery and improve the prognosis of patients.SEP,MEP and Scalp EEG can change according to cerebral ischemia,and the combination of them can improve the sensitivity and reliability of monitoring.Intraoperative neuroelectrophysiological monitoring technolo-gy is only an assistant means for prompting.The most important thing is to continuously improve the operation level of the surgeon,reduce occlusion time of cerebral blood flow and reduce the incidence of adverse events.