Precise MEP monitoring with a reduced interval is safe and useful for detecting permissive duration for temporary clipping
Precise MEP monitoring with a reduced interval is safe and useful for detecting permissive duration for temporary clipping
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DOI：
10.1038/s41598-020-60377-9
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发表时间：
2020-02-26
影响因子：
4.6
通讯作者：
Date, Isao
中科院分区：
文献类型：
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作者：
Kameda, Masahiro;Hishikawa, Tomohito;Date, Isao
尽管暂时夹闭载瘤动脉是颅内动脉瘤夹闭手术中不可或缺的技术，但暂时夹闭的允许持续时间仍不清楚。本研究的目的是证实精确运动诱发电位（MEP）监测的安全性，并根据精确MEP监测结果估计大脑中动脉（MCA）动脉瘤临时夹闭的允许时间。在每30秒至1分钟通过直接皮层刺激进行精确MEP监测的情况下，外科医生释放临时夹，并等待MEP振幅在临时夹持期间严重（>50%）降低后恢复。安全地进行了精确的MEP监测。在42例MCA动脉瘤夹闭手术中，进行了28例临时夹闭。由于精确的MEP监测可用于确定何时释放临时夹，即使由于长时间的临时夹闭导致MEP振幅严重降低，也没有患者发生永久性术后轻偏瘫。基于逻辑回归分析，如果应用临时剪辑312秒或更长时间，则MEP振幅严重降低的可能性更高。因此，我们应该在5分钟后释放临时夹子，以避免永久性术后轻偏瘫。
Although temporary clipping of the parent artery is an indispensable technique in clipping surgery for intracranial aneurysms, the permissive duration of temporary clipping is still not well known. The aim of this study is to confirm the safety of precise motor evoked potential (MEP) monitoring and to estimate the permissive duration of temporary clipping for middle cerebral artery (MCA) aneurysm based on precise MEP monitoring results. Under precise MEP monitoring via direct cortical stimulation every 30 seconds to 1 minute, surgeons released a temporary clip and waited for MEP amplitude to recover following severe (>50%) reduction of MEP amplitude during temporary clipping. Precise MEP monitoring was safely performed. Twenty-eight instances of temporary clipping were performed in 42 MCA aneurysm clipping surgeries. Because precise MEP monitoring could be used to determine when to release a temporary clip even with a severe reduction in MEP amplitude due to lengthy temporary clipping, no patients experienced permanent postoperative hemiparesis. Based on logistic regression analysis, if a temporary clip is applied for 312 seconds or more, there is a higher probability of a severe reduction in MEP amplitude. We should therefore release temporary clips after 5 minutes in order to avoid permanent postoperative hemiparesis.