皮质和头皮脑电监测研究前循环载瘤动脉临时阻断的安全时限

目的在皮质脑电和头皮脑电监测下，研究前循环动脉瘤术中载瘤动脉临时阻断的安全时限。方法在常温、常压下对行开颅手术的52例（58个）前循环动脉瘤病人行术中头皮脑电和皮质脑电双相监测，对术中有无临时阻断、阻断时间、术中脑电变化及术后有无阻断动脉相关缺血事件等进行综合分析。结果18例（19支血管）临时阻断后皮质脑电出现明显变化。皮质脑电重度变化在各主要血管阻断后均有出现。皮质脑电提示严重皮质缺血时，在10min内恢复脑血流者术后均未出现阻断载瘤动脉相关的缺血性并发症。结论在皮质脑电出现重度变化时，10min是最长的阻断安全时限。就个体而言，各主要血管对于临时阻断的耐受时限无区别。

Evaluation of safe time limit of temporary arterial occlusion in the surgery for anterior circulation aneurysm by cortical and scalp electroencephalography

Objective To study the safe time limit of temporary vascular occlusion during the surgery for anterior circulation aneurysm by cortical and scalp electroencephalography （EEG）. Methods The simultaneous cortical EEG and scalp EEG were performed prospectively in a cohort of 52 patients （58 aneurysms） during the surgery for anterior circulation aneurysm under normothermic and normotensive conditions. Cortical EEG was used for monitoring potential cortical ischemia and scalp EEG for the depth of anesthesia. The time of temporary arterial occlusion and changes of cortical EEG during the surgery and the postoperative procedure-related ischemic events were analyzed comprehensively. Results The significant cortical EEG changes were found in 19 arteries of 18 patients undergoing temporary occlusion. Cortical EEG had dramatic change after the major artery was occluded. When cortical EEG indicated serious ischemia, there was no postoperative ischemic complication associated with the procedure in patients whose vessels were occluded for less than 10 minutes. Conclusion When cortical EEG changed dramatically, 10 minutes may be the longest permissible time of temporary clamping of the cerebral artery without postoperative procedure-related complications. As far as each individual is concerned, the ability of major cerebral arteries to tolerate temporary occlusion may be not different.