神经电生理和微血管多普勒联合监测在颅内动脉瘤术中的应用研究

目的研究神经电生理和微血管多普勒超声（MDU）联合监测在颅内动脉瘤夹闭术中的应用价值和意义。方法颅内动脉瘤患者40例，共45个动脉瘤，在术中常规行头皮脑电图（EEG）、体感诱发电位（SSEP）、运动诱发电位（MEP）监测和夹闭动脉瘤前后行MDU以监测载瘤动脉和邻近血管血流动力学变化，将术后患者神经功能恢复情况与术中监测的变化作前瞻性研究。结果术后恢复良好35例，暂时性偏瘫3例。永久性偏瘫2例。术中SSEP变化4例，MEP变化7例，EEG变化2例，MDU发现血流异常9例．其中MDU与诱发电位（EP）均出现变化6例，在术中神经电生理监测未发现明显变化而MDU发现血流异常3例，另2例MDU正常而MEP出现变化。术中联合监测无变化或虽有变化但干预后恢复者术后神经功能良好。结论在颅内动脉瘤术中神经电生理和MDU联合监测的变化与神经功能状况具有良好的关联性。神经电生理在监测皮质、皮质下缺血和脑功能损害方面优于MDU，MDU在检测血管血流动力学方面优于神经电生理。神经电生理和MDU能相互弥补不足。二者联合监测可最大限度地减少动脉瘤手术并发症，提高手术质量。

Application of Intraoperative Neuroelectrophysiological and Microvascular Doppler Ultrasonography Monitoring in Intracranial Aneurysm Surgery

Objective To study the value and significance of intraoperative combined neuroelectro- physiological and microvascular Doppler ultrasonography （MDU） monitoring in clipping surgery for intracranial aneurysm. Methods Electroencephalogram（EEG）, somatosensory evoked potentials （SSEP）, motor evoked potentials （MEP） were monitored intraoperatively and MDU was used to examine the blood flow velocity in the parent vessels and adjacent vessels before and after aneurysm clipping in forty patients （forty-five aneurysms） who underwent surgery. Monitoring results, clinical outcome, and their correlation were prospectively analyzed. Results Thirty-five patients recovered well, three patients presented temporary hemiparesis, two patients left permanent hemiparalysis. Intraoperative SSEP changes occurred in four patients, MEP changes in seven patients, EEG changes in two patients and MDU disclosed o abnormal blood flow in nine patients. MDU and evoked potentials （EP） both changed in six cases which showed good consistency between these two sorts of monitoring measures. In other three cases, no significant change of intraoperative neuroelectrophysiological monitoring occurred during the operation, but MDU had abnormal blood flow and restored after proper intervention. Conclusions Results of intraoperative combined neuroelectrophysiological and MDU monitoring correlates well with postoperative imaging and neurological function in patients with intracranial aneurysms. Neuroelectrophysiology is better than MDU in monitoring cortical, subcortical ischemic damage and brain dysfunction, while MDU is superior to neuroelectrophysiological monitoring in detecting blood flow velocity. Neuroelectrophysiology and MDU can provide complementary information and cannot replace each other, and combined monitoring of them can upmostly reduce surgical complications of intracranial aneurysm and improve surgical quality.