Discrepancy Between Voluntary Movement and Motor-Evoked Potentials in Evaluation of Motor Function During Clipping of Anterior Circulation Aneurysms
Discrepancy Between Voluntary Movement and Motor-Evoked Potentials in Evaluation of Motor Function During Clipping of Anterior Circulation Aneurysms
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DOI：
10.1016/j.wneu.2013.08.034
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发表时间：
2014-12-01
影响因子：
2
通讯作者：
Mikuni, Nobuhiro
中科院分区：
文献类型：
--
作者：
Suzuki, Kengo;Mikami, Takeshi;Mikuni, Nobuhiro
背景：在外科动脉瘤夹闭术中，已经使用了多种方法来确定载瘤动脉或周围穿通动脉的血流，包括运动诱发电位(MEPS)、多普勒超声和吲哚青绿视频血管造影。然而，由于假阳性或假阴性错误，动脉血流不足引起的对侧偏瘫可能会发生。方法：4例脉络膜前动脉瘤患者和1例颈内动脉背侧动脉瘤患者为研究对象。结果：所有患者均安全成功夹闭动脉瘤，术后均无神经功能障碍。三名患者的自主活动和MEP结果与对照状态没有区别。在另外两名患者中，我们观察到MEP波幅和自主运动之间的差异。在1例患者中，在自主性运动恶化和随后的改善之前，在夹闭过程中MEP幅度降低。结论：清醒开颅脑动脉瘤夹闭术中的神经学评估是可行和安全的，对评估脑缺血，特别是脉络膜前动脉的缺血有一定的参考价值。从神经生理学的角度来看，MEP对于评估缺血条件下的自主活动可能不够敏感。
BACKGROUND: Various modalities have been used to confirm the blood flow through parent arteries or surrounding perforating arteries during surgical aneurysm clipping, including motor-evoked potentials ( MEPs), Doppler ultrasound, and indocyanine green videoangiography. Nonetheless, contralateral hemiparesis due to arterial blood flow insufficiency may arise because of false-positive or false-negative errors. By performing controlled intraoperative awakening during aneurysm clipping, we compared patients' voluntary movements with simultaneous MEP.METHODS: Four patients with anterior choroidal artery aneurysms and one patient with a dorsal internal carotid artery aneurysm were included in this study. MEP and intraoperative voluntary movements under awake craniotomy were assessed simultaneously during and after the clipping procedure.RESULTS: Aneurysms were safely and successfully clipped in all patients, with no evidence of postoperative neurological deficits. Voluntary movements and MEP findings did not differ from the control state in three patients. In the other two patients, we observed a discrepancy between MEP amplitudes and voluntary movements. In one patient, deterioration and subsequent improvement in voluntary movements were preceded by MEP amplitude reduction during clipping. In the other patient, MEP amplitude did not change although voluntary movement deteriorated during temporary occlusion of the internal carotid artery.CONCLUSIONS: Intraoperative neurological assessment during aneurysmal clipping under awake craniotomy is feasible and safe, and should be valuable for the assessment of ischemia, especially in the anterior choroidal artery. From a neurophysiologic viewpoint, MEP may be insufficiently sensitive for evaluating voluntary movement under ischemia.