Application Of Intraoperative Electrophysiological Monitoring In Intracranial Aneurysm Clipping

Objective:To explore the use value of electrophysiological monitoring in intracranial aneurysm clipping,and to explore the safe duration of temporary occlusion of artery under intraoperative electrophysiological monitoring,so as to provide a reference for the duration of temporary occlusion during the clipping of intracranial aneurysm.Methods:Based on a retrospective analysis of patients diagnosed with intracranial aneurysm in the Department of Neurology,Affiliated Hospital of Qingdao University from June 2019 to June 2020,the clinical data of 97 patients who underwent intraoperative electrophysiological monitoring were studied.All patients were diagnosed with intracranial aneurysm by CTA or DSA imaging before surgery and then microneurosurgery was performed.An intraoperative neuroelectrophysiological monitoring system was used for somatosensory evoked potential(SSEP),motor evoked potential(MEP)monitoring.Postoperative neurological function changes such as muscle strength were recorded.Cranial CT was reexamined within 24 hours,and cranial CTA or DSA was reexamined within 7 days.ROC curve was used to analyze the duration of temporary occlusion and the occurrence of intraoperative electrophysiological warning.Results:There were 123 intracranial aneurysms in 97 patients,122 of which were completely clipped.Among them,60 cases were temporarily broken during the operation,25 cases had cerebral ischemia events on the first day after the operation.After the active intervention,4 cases had not recovered their neurological function at discharge.Statistical analysis showed that Hunt-Hess grade(P<0.05),intraoperative temporary occlusion(P=0.000<0.050),and the number of intraoperative temporary occlusion(P<0.05)were related risk factors for postoperative cerebral ischemia events.The ROC curve was drawn for the duration of the temporary blockade and the occurrence of intraoperative electrophysiological warning.The area under the curve was 0.78(P<0.05),the 95%confidence interval was(0.651,0.908),the maximum Yuden index was 0.580,the threshold value was 372.5 seconds,the sensitivity was 0.818,the specificity was 0.762,the positive prediction rate was 66.67%,and the negative prediction rate was 90.70%.The ROC curve was drawn for the duration of temporary occlusion and the time of postoperative ischemia.The area under the curve was 0.667(P<0.05),the 95% confidence interval was(0.510,0.824),the cutoff value corresponding to the maximum Yuden index 0.433 was430.5 seconds,the sensitivity was 0.592,the specificity was 0.842,and the positive prediction rate was 68.42% and the negative prediction rate was 78.05%.The sensitivity,specificity,Yuden index,positive prediction rate,and negative prediction rate were 64.29%,90.63%,0.549,85.71%,and 74.36% respectively for the gold standard of temporary occlusion duration of 6 minutes.Conclusion:1.Hunt-Hess grading and intraoperative temporary occlusion are risk factors for postoperative cerebral ischemia events.2.In this study,intraoperative temporary occlusion was kept within 6 min as far as possible to help reduce ischemic events;If accompanied by electrophysiological monitoring,the time of occlusion can be better controlled and even appropriately prolonged.