颅内动脉瘤术中阻断载瘤动脉后脑供血状态的神经电生理监测

目的探讨颅内动脉瘤夹闭术中载瘤动脉临时阻断后，神经电生理监测对判断脑缺血的价值。方法对63例颅内动脉瘤夹闭术患者行载瘤动脉临时阻断。术中行体感诱发电位（SEP）和脑电图实时监测，观察载瘤动脉临时阻断后对神经电生理指标的影响。结果63例中，术后12例发生脑梗死。①术中SEP的P40下降≥50％者16例，9例术后发生脑梗死（56.2％）；P40下降〈50％者47例，3例术后发生脑梗死（6.4％），脑梗死发生率比较，差异有统计学意义，P〈0.01。②9例有脑电图改变（14％），其中8例松开或调整阻断夹2min后，恢复正常；另1例术后恢复80％。脑电图主要表现为快活动α波轻度减少，慢活动θ波增加30％-40％，δ波波幅无明显变化。③63例载瘤动脉被阻断时间为3-59min，阻断时间〈16min者23例，均无脑梗死发生；≥16min者40例，12例发生脑梗死。结论术中动态监测SEP、脑电图的变化，可为判断阻断区脑缺血状态提供重要的信息；为术者提供临时血管阻断的时限信息，并对术后出现脑梗死有重要的预警作用。

Intraoperative neuroelectrophysiological monitoring of cerebral blood supply after parent-artery occlusion during intracranial aneurysm surgery

Objective To investigate the value of neuroelectrophysiological monitoring in determining cerebral ischemia during temporary arterial occlusion （TAO） of parent vessels in intracranial aneurysm clipping. Methods TAO of parent vessels was performed in 63 patients undergoing intracranial aneurysm clipping. Intraoperative somatosensory evoked potentials （SEP） and electroencephalogram （EEG） were performed for real-time monitoring. The effect of TAO of parent vessels on neuroelectrophysiological indexes was observed. Results Cerebral infarction were happened in 12 cases after surgery.①Nine of 16 （56.2%） patients whose intraoperative P40 decreased ≥50% had cerebral infarction, 3 of 47 （6.4%） patients whose intraoperative P40 decreased 〈 50% had cerebral infarction, the probability of occurring postoperative cerebral infarction increased significantly. The incidence of cerebral infarction was statistical significance between two groups（ P 〈 0.01）.②In 9 cases （14%）who had electroencephalogram changes, 8 cases returned to normal state 2 min later after unclamping or adjusting blockade clamps and 1 case returned about 80% after surgery. The EEG mainly revealed a slight decrease in α wave, the θ wave increased 30% to 40%, and the 8 wave ampfitude had no significant change.③The duration of TAO of the parent vessels in 63 patients were 3 to 59 minutes. Twenty-three patients whose occlusion time 〈 16 minutes did not had cerebral infarction; 12 of 40 patients whose occlusion time ≥ 16 minutes had cerebral infarction. Conclusion Intraoperative monitoring the changes of SEP and the changes of EEG may provide important information for the state of cerebral ischemia in the blocked areas and tolerance of the brain, provide important informations of TAO for surgeons, and provide important warning for avoiding postoperative cerebral infarction.