神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.     

神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.     

颅内动脉瘤术中诱发电位监测的初步探讨

目的 初步探讨颅内动脉瘤手术中躯体感觉诱发电位、脑干听觉诱发电位及运动诱发电位的临床应用价值.方法 在16例动脉瘤手术中开展诱发电位监测,观察术中电生理信号改变与术后神经功能状态的关系.结果 11例术中未出现电生理信号异常改变,5例术中出现了异常信号,其中信号未能恢复正常的4例术后均出现新发神经功能障碍.结论 诱发电位监测可实时了解颅内动脉瘤手术中有无脑缺血所致的神经功能障碍,对指导手术及评估预后均有重要意义.

Abstract：

Objective To explore the application of intraoperative neuroelectrophysiological monitoring on somatosensory evoked potentials (SEP), brainstem auditory evoked potentials (BAEP) and motor evoked potentials (MEP) during intracranial aneurysm surgery.Methods SEP, BAEP or MEPs were monitored during operations on 16 patients with intracranial aneurysms.The relationship between the intraoperative changes of electrophysiological signals and the postoperative outcomes of neurological deficits was evaluated.Results 11 patients without abnormal intraoperative electrophysiological signal changes demonstrated no new neurological deficits after surgery.However, in the left 5 patients, abnormal changes of intraoperative electrophysiological signals were detected.Among these 5 patients, 4 with abnormal electrophysiological signals which were not recovered intraoperatively demonstrated new developed functional deficits immediately after surgery.Conclusion During intracranial aneurysm surgery, the monitoring on SEP, MEP and BAEP is beneficial not only to timely detecting neurological functional deficits resulted from intraoperative cerebral ischemia, but also to properly guiding surgical manipulation, and to reliably predicting postoperative outcome as well.     

体感诱发电位监测在前循环动脉瘤血管内介入治疗中的应用

目的 探讨体感诱发电位(SEP)监测技术在颅内前循环动脉瘤血管内介入治疗中的应用价值.方法 将2007年3月至2010年7月期间102例前循环动脉瘤血管介入栓塞术患者根据研究开始前生成的随机编码入组,52例术中进行SEP动态监测,50例术中未用该监测手段,对比分析两组术后1 d新发神经功能障碍及6个月后随访的预后情况(良好、致残、死亡).结果 两组患者术后出现新的神经功能障碍例数差异有统计学意义(P<0.01),6个月后随访预后良好和致残比率组间差异均有统计学意义(P＜0.05),而死亡率组间差异无统计学意义(P＞0.05).结论 在介入栓塞术中应用SEP监测可以早期反映前循环供血区神经组织由于缺血引起的功能异常,并及时给予术中干预,对降低患者致残率及提高预后良好率有极其重要的意义.

Abstract：

Objective We applied somatosensory evoked potential(SEP)monitoring during endovascular embolization for intracranial anterior circulation aneurysm,and explored the values.Methods From March 2007 to July 2010 we treated 102 patients of intracranial anterior circulation aneurysm with endovascular embolization.102 patients were randomly classified two groups,group one with 52 patients with SEP monitoring and group two with 50 patients without SEP monitoring.Postoperative new nerve impairment and prognosis(good prognosis,disability,death)at the six month after leaving hospital of two groups were compared statistically.Results Comparing the monitoring group with the non-monitoring group,the numbers of patients with postoperative new nerve impairment was statistically significant differences(P＜0.01),the rates of good prognosis and disability were statistics difference(P＜0.05).But there was not statistics difference at the rates of death(P＞0.05).Conclusions Applying SEP monitoring in endovascular embolization can early reflect abnormal function of the brain tissue which supplied by anterior circulation.It is significant to reduce the occurrence of disability and improve prognosis.     

颅内镜像动脉瘤17例临床分析

目的 探讨颅内镜像动脉瘤的临床特征和手术方法.方法 解放军第二五一医院神经外科自2006年1月至2010年6月行显微外科手术治疗颅内镜像动脉瘤患者17例,回顾性分析患者的临床资料和疗效.结果 本组动脉瘤直接夹闭35个,未作处理1个,患者行一期手术9例,夹闭动脉瘤20个.二期手术7例,第一次手术夹闭动脉瘤7个,第二次手术夹闭动脉瘤7个.1例患者行一侧动脉瘤夹闭后对侧动脉瘤未处理;11例患者术后行CTA复查,夹闭的23个动脉瘤中2例瘤颈残留,余动脉瘤均消失,载瘤动脉通畅.GOS评分显示恢复优良12例,轻残4例,重残1例.结论 显微外科手术治疗颅内镜像动脉瘤效果显著.正确判断责任动脉瘤并首先处理,根据动脉瘤的部位、Hunt-Hess临床分级及患者周身状况等选择一期、分期手术可达到良好效果.

Abstract：

Objective To study the clinical characteristics and microsurgical skills of intracranial mirror-image aneurysm. Methods The clinical data and post-operative outcomes of 17 patients with 36 intracranial mirror-image aneurysms who underwent microsurgical operation were analyzed retrospectively. Results Thirty-five aneurysms were clipped directly and 1 did not give any treatment. One-time surgery was performed in 9 patients and 20 aneurysms were clipped. Two-stage operation was performed in the other 7 patients: 7 aneurysms were clipped in the first surgery and 7 in the second one. One patient received aneurysm clipping only in one side of the brain. CTA was performed again on 11 patients, noting that residual aneurysm neck of the 2 aneurysms existed in 23 clipped aneurysms, that the other aneurysms disappeared, and that the parent arteries were clear. GOS indicated that good surgical outcomes were achieved in 12 patients, light disability in 4 and severe disability in 1.Conclusion The surgical outcomes of intracranial mirror-image aneurysm performed microsurgical operation are predominance. Criminal aneurysms should be determined correctly and clipped firstly; and according to the sites and grades of the aneurysms and the patient's condition, good outcomes can be achieved by choosing one-time operation or two-stage operation.     

西藏高原地区血管内介入治疗破裂颅内动脉瘤

目的 探讨西藏高原地区经血管内介入治疗破裂出血的颅内动脉瘤的安全性、有效性及可行性.方法 回顾性分析2010年1月至2010年11月我院经血管内介入治疗的8例破裂出血的颅内动脉瘤.8例患者均行DSA检查确诊,并根据动脉瘤的特点实施个性化血管内介入治疗:5例行弹簧圈栓塞术,2例行支架辅助弹簧圈栓塞术,1例行单纯支架贴敷术.结果 8例中完全栓塞6例,次全栓塞1例,单纯支架贴敷1例.术中复查DSA显示:动脉瘤显影消失7例,单纯支架置入后瘤腔内对比剂滞留1例.1例宽颈动脉瘤行支架辅助弹簧圈栓塞术后出现对侧肢体偏瘫(肌力0级),经给予加强抗凝、抗血小板聚集、改善微循环等治疗后,下肢肌力恢复至Ⅴ级,上至肌力恢复至接近Ⅴ级.除术前Hunt-Hess分级Ⅳ级、GCS评分4分的1例因继发严重脑积水恢复至Hunt-Hess分级Ⅲ级、GCS评分7分外,其余7例均恢复正常.门诊随访1-5个月,无再出血或缺血事件发生.结论 高原地区经血管内介入治疗破裂出血的颅内动脉瘤是安全、有效的,但围手术期的处理具有高原特色.

Abstract：

Objective To evaluate the safety, efficacy and feasibility of endovascular interventional therapeutic techniques for ruptured hemorrhagic intracranial aneurysms in highland in Tibet. Methods Retrospectively analyzed the therapeutic effects of endovascular interventional treatment for ruptured hemorrhagic intracranial aneurysms in 8 cases in highland in Tibet 8 cases were performed DSA for accurate diagnosis and individualized endovascular interventional treatment were undergone according to the feature of the aneurysms; coiling in 5 cases, coiling with assistance of stent in 2 and pure stenting in 1. Results Among the 8 cases complete embolization was gained in 6 and hypo - complete embolization in 1. DSA review during procedure showed the image of aneurysm disappeared in 7 cases and retention of contrast agent inside the aneurysm in the case which was purely stented. Contralateral hemiplegia of limbs which muscle strength was 0 grade occurred in 1 case with wide - necked aneurysm treated by coiling with stent assistance after procedure. After the intensive treatment of antiplatelet, anticoagulation and to improve microcirculation, the muscle strength recovered to Ⅴ grade in the lower limb and near Ⅴ grade in the upper limb. After procedure except 1 case whose Hunt & Hess grade was in Ⅵ and GCS was 4 improved Hunt & Hess grade to Ⅲ and GCS to 4 because of secondary severe hydrocephalus, the other cases were all well recovered. During 1 to 5 months following - up of outpatient no re - hemorrhagic or ischemic event occurred. Conclusions Endovascular interventional treatment is safe, mini- invasive, effective and feasible for ruptured hemorrhagic intracranial aneurysms in highland in Tibet, but the peri - operative management was highland characteristic.     

显微手术治疗颅内血栓性巨大动脉瘤11例报告

目的 探讨颅内血栓性巨大动脉瘤的临床特点、手术方法和效果.方法 回顾性分析11例颅内血栓性巨大动脉瘤患者的临床表现、临床分型、手术方法及治疗效果.结果 手术方式包括动脉瘤夹闭、载瘤动脉塑形加血栓切除9例,动脉瘤孤立加血栓切除1例,颈内动脉颅外段结扎1例.10例术后复查DSA或CTA提示动脉瘤均消失.随访3-6个月,GOS评分恢复优良8例,轻残1例,重残1例,死亡1例.结论 颅内巨大血栓性动脉瘤手术治疗困难,载瘤动脉临时阻断、动脉瘤切开血栓清除、载瘤动脉塑形及术中微血管多普勒监测(MVD)是治疗血栓性巨大动脉瘤的主要方法.

Abstract：

Objective To study the clinical features and surgical management of intracranial thrombotic giant aneurysms.Methods A retrospective study was performed for 11 patients with intracranial thrombotic giant aneurysms.The clinical presentation, clinical classification, surgical approaches and therapeutic efficacy were reviewed.Results The treatment included thrombectomy - aneurysm clip reconstruction in 9 cases, thrombectomy - aneurysm isolate in 1, and cervical internal carotid artery ligation in 1.The postoperative DSA or CTA showed that complete angiographic obliteration was achieved in 10 cases.Follow - up period was from 3 months to 6 months, the clinical outcomes of these patients were evaluated by Glasgow Outcome Scale grades.GOS of 8 cases were improved.There were minor deficit in 1 case, major deficit in 1 and one death.Conclusions The surgical treatment for intracranial thrombotic giant aneurysms is very difficult.It is a good method to occlude the parent artery temporally, eliminate intraaneurysmal thrombus and reconstruct parent artery.Intraoperative microvascular Doppler sonography (MVD) monitoring is helpful.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

The use of electrophysiological monitoring in the intraoperative management of intracranial aneurysms

OBJECTIVES: Somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) have been increasingly utilised during surgery for intracranial aneurysms to identify cerebral ischaemia. Between July 1994 and April 1996, we surgically treated 70 aneurysms in 49 consecutive patients (58 operations) with the aid of intraoperative evoked potential monitoring. This study sought to evaluate the usefulness of SSEP and BAEP monitoring during intracranial aneurysm surgery. METHODS: Mean patient age was 51.9 (range 18-79) years. The sizes of the aneurysms were 3-4 mm (15), 5-9 mm (26), 10-14 mm (11), 15-19 mm (seven), 20-24 mm (six), and >25 mm (five). SSEPs were monitored in 58 procedures (100%) and BAEPs in 15 (26%). The neurological status of the patients was evaluated before and after surgery. RESULTS: Thirteen of the 58 procedures (22%) monitored with SSEPs had SSEP changes (12 transient, one persistent); 45 (78%) had no SSEP changes. Three of 15 patients (20%) monitored with BAEPs had changes (two transient, one persistent); 12 (80%) had no BAEP changes. Of the 14 patients with transient SSEP or BAEP changes, these changes resolved with adjustment or removal of aneurysm clips (nine), elevating MAP (four), or retractor adjustment (one). Mean time from precipitating event to electrophysiological change was 8.9 minutes (range 3-32), and the mean time for recovery of potentials in patients with transient changes was 20.2 minutes (range 3-60). Clinical outcome was excellent in 39 patients, good in five, and poor in three (two patients died), and was largely related to pretreatment grade. CONCLUSIONS: SSEPs and BAEPs are useful in preventing clinical neurological injury during surgery for intracranial aneurysms and in predicting which patients will have unfavourable outcomes.     

Monitoring of sensory evoked potentials during surgery of skull base tumours

Despite advances in instrumentation and the use of microsurgical techniques, neurosurgical procedures involving extensive areas of skull base or other critical areas of brain still carry significant risk for neurological injury. The use of intraoperative recording of sensory evoked potentials (SEP) has been advocated to monitor neurologic function during these major neurosurgical procedures to reduce the risk of injury to neural structures. This report summarizes our experience with intraoperative monitoring of SEP in over 200 patients, and details our findings in a group of 12 patients with skull base and posterior fossa tumours. Somatosensory evoked potentials (SSEP) were monitored in all patients, and brain stem auditory evoked potentials (BAEP) in five. While minor changes in BAEP and SSEP parameters were noted in most patients, significant changes occurred in five. Irreversible loss of BAEP in one patient was associated with complete hearing loss postoperatively. Marked, persistent alteration of both BAEP and SSEP was associated with postoperative brainstem dysfunction. No patient with stable BAEP and SSEP at the end of the procedure suffered additional neurological deficit. We conclude that intraoperative SEP monitoring may be valuable in minimizing neural injury during major neurosurgical procedures.     

卡马西平对诱发电位的影响及意义

目的研究长期口服卡马西平治疗癫对诱发电位的影响,并讨论其意义。方法选择尚未治疗的癫病人31例作为试验组;以性别、年龄与癫组相匹配的健康正常人26例作为对照组。两组先分别做脑干听觉诱发电位(BAEP)、事件相关电位P300、视觉诱发电位(VEP)和体感诱发电位(SEP),之后癫组开始卡马西平治疗,服药一年后再作上述各项检查。结果癫组病人治疗前各项电生理学指标与正常对照组相比无显著性差异;癫组卡马西平治疗后各项电生理指标与治疗前相比BAEP各波、P300以及VEP的P100波潜伏期均显著延长;SEP的潜伏期无显著变化。结论神经电生理学检查可以早期发现长期服用卡马西平导致的亚临床毒性。     

Evoked potentials in the Rett syndrome

In order to have an electrophysiological approach to the pathogenesis of the Rett syndrome (RS), EEG testing together with evoked potential studies were performed in five children with RS, observed in our hospital during the last three years. All of the patients, aged from 18 months up to 4.5 years, had abnormal EEG: normal background activity with paroxysmal, epileptiform discharges was seen. In contrast with the abnormal EEGs, the evoked potentials were normal in each patient: brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP), and central conduction time (CCT) of somatosensory evoked potentials (SSEP). These findings together with the few previous ones suggest a predominantly gray matter pathophysiology in the early stages of RS.     

听觉诱发电位及体感诱发电位在颅脑外伤致昏迷患者的应用

严重颅脑损伤昏迷患者脑功能的监测是判断预后和指导治疗的重要手段。听觉诱发电位(BAEP)及体感诱发电位(SSEP)因其方便、无创并能连续实时监测昏迷患者相关神经传导通路电生理的变化,间接反映脑干上行激活系统、大脑皮层结构与功能的完整性,越来越成为临床对严重颅脑损伤昏迷患者预测预后和指导治疗的重要手段。本文就近年来相关研究进行综述,旨在指导临床实践。     

Re-evaluation of short latency somatosensory evoked potentials (P13, P14 and N18) for brainstem function in children who once suffered from deep coma

One of the major clinical features of brain death is deep coma. Therefore, we re-evaluated retrospectively electrophysiological examinations of brainstem function in about 31 children who had once suffered from deep coma in order to reveal its pathophysiological characteristics. The patient age at coma ranged from 1 month to 10 years (mean 2 years 1 month). The electrophysiological examinations were performed, including any of short-latency somatosensory evoked potential (SSEP), brainstem auditory evoked potential (BAEP) and blink reflexes. We first compared results between the fair and poor prognostic groups, and then re-evaluated SSEP results on a few severely impaired patients with persistent vegetative state (PVS). Subsequently, SSEP clarified more specific findings for a deep coma condition than BAEP and blink reflex. A lack of P14, N18 and N20, and an amplitude reduction or vagueness of P13 in SSEP in these children strongly suggested high risk in their future neurological prognosis. In conclusion, electrophysiological examinations, especially SSEP (P13, P14 and N18), might be very useful in obtaining a long-term neurological prognosis after deep coma in children.     

支架置入术对椎基底动脉系统短暂性脑缺血发作患者诱发电位的影响

目的 观察支架置入术能否改善椎基底动脉系统短暂性脑缺血发作（TIA）患者的亚临床症状。方法 11例症状性椎基底动脉狭窄的椎基底动脉系统TIA患者,支架置入术前后分别检测体感诱发电位（SEP）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）,记录各诱发电位的潜伏期及波幅。结果 （1）术前诱发电位均异常,主要表现为SEP N20及P40潜伏期异常,BAEPⅠ、Ⅲ、Ⅴ波潜伏期延长,VEP P100潜伏期延长。（2）与术前相比,术后1周BAEP表现为Ⅰ～Ⅲ波潜伏期缩短（P =0.046）、Ⅲ波幅升高（P =0.05）;SEP表现为N20潜伏期缩短（P =0.012）,N13～N20间期缩短（P =0.013）,P14～N20间期缩短（P =0.005）;VEP表现为 P100潜伏期缩短（P =0.022）。结论 支架置入术后,椎基底动脉系统TIA患者的SEP、BAEP、VEP好转,提示患者的亚临床症状恢复。     

The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis.

In a prospective study, we evaluated the technique of magnetically evoked motor potentials (MEP) in the diagnosis of multiple sclerosis (MS). We consecutively included 68 patients with symptoms or signs compatible with a demyelinative CNS affection. We subjected all patients to CSF analysis, MRI studies of the brain and brainstem, visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP), and somatosensory evoked potentials (SSEP). We then used the results to categorize the patients according to the Poser criteria of multiple sclerosis. Blinded from the results of the above investigations, one of the authors made MEP recordings from three muscles in the upper limbs and two in the lower limbs in all 68 patients. Forty patients received an MS diagnosis, and in these, MRI was positive in 88%, MEP in 83%, VEP in 67%, SSEP in 63%, and BAEP in 42%. As to the diagnosis of MS, the reliability of a prolonged central motor conduction time (CMCT) was 0.83 (0.73 to 0.93), while the reliability of a normal CMCT was 0.75 (0.61 to 0.98). The information gained by MRI was best supplemented by VEP. Of the neurophysiologic tests, the MEP was in closest agreement with the MRI with a concordance of 85%.     

诱发电位监测在脑血管病阻断陛介人治疗中的应用

目的探讨诱发电位监测在脑血管病阻断性介入治疗中的应用价值。方法13例行阻断性介入治疗（包括球囊辅助栓塞、主干动脉闭塞）的脑血管病患者行术中全程诱发电位监测,观察是否出现脑缺血并调整策略。结果7例颅内动脉瘤及1例颈内动脉海绵窦瘘行球囊闭塞试验后永久闭塞主干动脉。1例颈内动脉海绵窦段动脉瘤合并烟雾病者,球囊充盈95S内出现体感诱发电位异常改变,抽瘪球囊后波形恢复,据此调整球囊充盈时间并完成治疗,未发生缺血。5例颅内动脉瘤行球囊辅助弹簧圈栓塞成功。术后3d及出院时诱发电位监测均无缺血性波形改变。所有病例随访6个月,均无新发缺血事件;MRI检查示,除原发疾病外,未发现缺血性改变。结论作为反映脑组织缺血的灵敏指标,诱发电位监测可成为脑血管病阻断性介入治疗的常规辅助技术,以减少并发症,提高疗效。