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Diagnostic impact of monitoring transcranial motor-evoked potentials to prevent ischemic complications during endovascular treatment for intracranial aneurysms.
Neurosurgical Review ( IF 2.8 ) Pub Date : 2020-06-23 , DOI: 10.1007/s10143-020-01338-8
Ichiro Nakagawa 1 , HunSoo Park 1 , Masashi Kotsugi 1 , Yasushi Motoyama 1 , Kaoru Myochin 2 , Yasuhiro Takeshima 1 , Ryosuke Matsuda 1 , Fumihiko Nishimura 1 , Syuichi Yamada 1 , Tsunenori Takatani 3 , Kimihiko Kichikawa 2 , Hiroyuki Nakase 1
Affiliation  

The present study aimed to determine the incidence of intraprocedural motor-evoked potential (MEP) changes and to correlate them with intraprocedural ischemic complications and postprocedural neurological deficits in patients after endovascular intracranial aneurysm treatment. This study analyzed data from 164 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms under transcranial MEP monitoring. We analyzed associations between significant changes in MEP defined as > 50% decrease in amplitude, and intraprocedural complications as well as postoperative neurological deficits. Factors associated with postprocedural neurological deficits were also assessed. The treated aneurysms were predominantly located in the anterior circulation (71%). Fourteen (9%) were located at perforators or branches that supplied the pyramidal tract. Intraprocedural complications developed in eight (5%) patients, and four of eight (50%) patients occurred postprocedural neurological deficits. Significant intraprocedural MEP changes occurred during seven of eight endovascular procedures associated with intraprocedural complications and salvage procedures were performed immediately. Among these changes, four transient MEP changes, recovered within 10 min, were not associated with postprocedural neurological deficits, whereas three permanent MEP changes were associated with postprocedural neurological deficits and mRS ≥ 1 at discharge. Aneurysms located at perforators/branches supplying the pyramidal tract, and permanent intraprocedural MEP changes were associated with postprocedural neurological deficits. We conclude that intraprocedural transcranial MEP monitoring can reliably identify ischemic changes and can initiate prompt salvage procedures during endovascular aneurysm treatment.



中文翻译:

监测颅内运动诱发电位对颅内动脉瘤血管内治疗期间预防缺血性并发症的诊断作用。

本研究旨在确定血管内颅内动脉瘤治疗后患者术中运动诱发电位(MEP)变化的发生率,并将其与术中缺血性并发症和术后神经功能缺损相关。这项研究分析了经颅MEP监测的164例接受血管内线圈栓塞治疗颅内动脉瘤的连续患者的数据。我们分析了定义为振幅降低> 50%的MEP的显着变化与术中并发症以及术后神经功能缺损之间的关联。还评估了与术后神经功能缺损相关的因素。治疗的动脉瘤主要位于前循环(71%)。14个(9%)位于提供锥体束的穿孔器或分支处。术中并发症发生在八名(5%)患者中,八名患者中有四名(50%)发生了术后神经功能缺损。在八次与术中并发症相关的血管内手术中,有七次发生了术中MEP的明显变化,并立即进行了挽救程序。在这些变化中,有四个短暂的MEP变化(在10分钟内恢复)与术后神经功能缺损无关,而三个永久性MEP变化与术后神经功能缺损和出院时mRS≥1相关。位于供应锥体束的穿孔器/分支处的动脉瘤和永久性的术中MEP改变与术后神经功能缺损相关。

更新日期:2020-06-24
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