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Intraoperative Neurophysiological Monitoring in Aneurysm Clipping: Does It Make a Difference? A Systematic Review and Meta-Analysis
Clinical Neurology and Neurosurgery ( IF 1.8 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.clineuro.2020.105954
Davide Nasi 1 , Stefano Meletti 2 , Vincenzo Tramontano 2 , Giacomo Pavesi 1
Affiliation  

The use of intraoperative neurophysiological monitoring (IOM) has been proposed to prevent new neurological deficit during aneurysm clipping. The purpose of this meta-analysis was to evaluate if IOM can prevent neurological injury during clipping of intracranial aneurysm. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological deficit in patients who had a surgical clipping with and without IOM. Of the 268 citations screened, four studies (including 873 patients) met the inclusion criteria and were included in the meta-analysis. Patients who received surgery with IOM had less new neurological deficit than those who underwent surgery without it (p = 0,04). This finding was more significant in the subgroup analysis of two studies focused on middle cerebral artery (MCA) aneurysm (p = 0,02). However, a specific analysis of the three studies reporting the results of IOM to prevent permanent deficit revealed that there is only a trend for less neurological events in monitored patients without statistically significance (p = 0,05). The use of IOM during clipping of intracranial aneurysm was associated with less new neurological deficit with the obtained evidence of the included studies. However, at long-term follow-up the use of IOM did not correlate with a significant improvement in neurological outcome.

中文翻译:

动脉瘤夹闭术中的神经生理监测:有区别吗?系统评价和元分析

已提议使用术中神经生理监测 (IOM) 来预防动脉瘤夹闭期间新的神经功能缺损。本荟萃分析的目的是评估 IOM 是否可以预防颅内动脉瘤夹闭过程中的神经损伤。我们使用系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行系统评价和荟萃分析,我们回顾了临床比较研究,这些研究评估了有和没有 IOM 的手术夹闭患者的新神经功能缺损率。在筛选的 268 篇引文中,4 项研究(包括 873 名患者)符合纳入标准并被纳入荟萃分析。接受 IOM 手术的患者比没有接受手术的患者新出现的神经功能缺损更少 (p = 0,04)。这一发现在针对大脑中动脉 (MCA) 动脉瘤的两项研究的亚组分析中更为显着 (p = 0,02)。然而,对报告 IOM 结果以防止永久性缺陷的三项研究的具体分析表明,在没有统计学意义的受监测患者中,只有较少神经系统事件的趋势(p = 0.05)。根据纳入研究获得的证据,在夹闭颅内动脉瘤期间使用 IOM 与较少的新神经功能缺损相关。然而,在长期随访中,IOM 的使用与神经学结果的显着改善无关。对报告 IOM 预防永久性缺损结果的三项研究进行的具体分析表明,在没有统计学意义的受监测患者中,只有较少神经系统事件的趋势(p = 0.05)。根据纳入研究获得的证据,在夹闭颅内动脉瘤期间使用 IOM 与较少的新神经功能缺损相关。然而,在长期随访中,IOM 的使用与神经学结果的显着改善无关。对报告 IOM 预防永久性缺损结果的三项研究的具体分析表明,受监测患者仅存在较少神经系统事件的趋势,但没有统计学意义(p = 0.05)。根据纳入研究获得的证据,在夹闭颅内动脉瘤期间使用 IOM 与较少的新神经功能缺损相关。然而,在长期随访中,IOM 的使用与神经学结果的显着改善无关。
更新日期:2020-09-01
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