Usefulness of Transcranial Motor Evoked Potential in Clipping Surgery for Cerebral Aneurysms-Introduction of a New Protocol for Stable Monitoring

被引:1
作者
Sasaki, Tatsuya [1 ]
Murakami, Kensuke [1 ,2 ]
Saito, Atsushi [1 ,3 ]
Haryu, Shinya [1 ]
Kameyama, Masayuki [1 ]
Takahashi, Yoshiharu [1 ]
Takamuro, Satoru [4 ]
Kato, Nana
Endo, Toshiki [1 ]
机构
[1] Tohoku Med & Pharmaceut Univ, Div Neurosurg, 1-15-1 Fukumuro,Miyagino ku, Sendai, Miyagi 9838536, Japan
[2] Aomori Prefectural Cent Hosp, Dept Neurosurg, Aomori, Aomori, Japan
[3] Hirosaki Univ, Dept Neurosurg, Hirosaki, Aomori, Japan
[4] Tohoku Med & Pharmaceut Univ, Sch Med, Sendai, Miyagi, Japan
关键词
motor evoked potential; cerebral aneurysm; transcranial stimulation; hemiparesis; threshold; BLOOD-FLOW INSUFFICIENCY; ARTERY; STIMULATION; INJURY;
D O I
10.2176/jns-nmc.2023-0007
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The usefulness of transcranial motor evoked potentials (Tc-MEPs) in clipping surgery has been reported. However, numerous false positive and false negative cases were reported. We report the usefulness of a new protocol compared with direct cortical MEP (Dc-MEP). Materials were 351 patients who underwent aneurysmal clipping under simultaneous monitoring of Tc- and Dc-MEPs. A total of 337 patients without hemiparesis and 14 with hemiparesis were separately analyzed. Intraoperative changes of Tc-MEP thresholds were examined in the first 50 patients without hemiparesis. The stimulation strength of Tc-MEP was set at +20% of the stimulation threshold. As thresholds changed intraoperatively, thresholds were examined every 10 min and changed stimulation strength. Stimulation thresholds of Tc-MEP were significantly decreased after craniotomy and significantly increased after CSF aspiration. The recording ratios of Tc- and Dc-MEPs were 98.8% and 90.5%, respectively. Out of 304 patients without MEP change, 5 patients developed transient or mild hemiparesis with infarction of the territory of the perforating artery arising from the posterior communicating artery. Out of 31 patients whose MEP transiently disappeared, 3 patients developed transient or mild hemiparesis. The other two patients without MEP recovery manifested persistent hemiparesis. In 14 patients with preoperative hemiparesis, 3 patients whose healthy/affected ratio of Tc-MEP was large developed severe persistent hemiparesis. We clarified the intraoperative changes of Tc-MEP thresholds for the first time. A new protocol of Tc-MEP that followed thresholds and changed stimulation strength to +20% of thresholds is useful for stable monitoring. The usefulness of Tc-MEP is the same as that or better than that of Dc-MEP.
引用
收藏
页码:409 / 419
页数:11
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