上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (12): 1733-.doi: 10.3969/j.issn.1674-8115.2011.12.016

• 论著（临床研究） • 上一篇    下一篇

体感诱发电位和微血管多普勒超声在颅内动脉瘤夹闭术中的联合应用

费智敏1, 张 珏2, 书国伟2, 蔡佩浩1, 王静予1, 邱 锋1, 孔令军1, 许乐宜1, 龚 立1, 王夏飞1, 李善泉2   

  1. 1.上海中医药大学附属曙光医院神经外科, 上海 201203； 2.上海交通大学 医学院附属仁济医院神经外科, 上海 200127
  • 出版日期:2011-12-28 发布日期:2012-01-04
  • 通讯作者: 张 珏, 电子信箱: zhangjue_sunrun@hotmail.com。
  • 作者简介:费智敏（1968—）, 男, 副主任医师, 硕士；电子信箱: tommyfei@126.com。
  • 基金资助:

    上海市卫生局基金(2010139)

Application of intraoperative somatosensory evoked potential combined with microvascular Doppler sonography in intracranial aneurysm clipping surgery

FEI Zhi-min1, ZHANG Jue2, SHU Guo-wei2, CAI Pei-hao1, WANG Jing-yu1, QIU Feng1, KONG Ling-jun1, XU Le-yi1, GONG Li1, WANG Xia-fei1, LI Shan-quan2   

  1. 1.Department of Neurosurgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China；2.Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-12-28 Published:2012-01-04
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2010139

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摘要：

目的 探讨体感诱发电位（SEP）和微血管多普勒超声(MDS)在颅内动脉瘤夹闭术中联合应用的价值。方法 采用SEP和MDS对53例患者（共57个颅内动脉瘤）手术进行术中监测，根据术中SEP和MDS的变化调整瘤夹。术后复查数字减影血管造影（DSA）；术后1个月进行格拉斯哥预后评分(GOS)。结果 术中所有患者均未发生SEP持续变化。9例(17.0％)应用MDS协助定位动脉瘤或判断载瘤动脉走行，夹闭后3个(5.3％)瘤体内仍存在血流信号，调整瘤夹至无血流信号。6例(11.3％)夹闭后载瘤动脉狭窄，调整瘤夹位置至MDS恢复正常。术后50例DSA检查未见瘤体残留，载瘤动脉与邻近血管通畅，与术中SEP和MDS监测结果一致。术后1个月随访，死亡2例；其余患者GOS 5分者41例，４分8例，3分1例，2分1例。结论 颅内动脉瘤夹闭术中联合应用SEP和MDS是一种无创、方便、有效的术中监测技术，有助于提高手术疗效。

关键词: 体感诱发电位, 微血管多普勒超声, 术中监测, 动脉瘤, 夹闭术

Abstract:

Objective To evaluate the application of intraoperative somatosensory evoked potential (SEP）combined with microvascular Doppler sonography (MDS) in intracranial aneurysm clipping surgery. Methods Fifty-three patients with a total of 57 intracranial aneurysms undergoing intraoperative intracranial aneurysm clipping surgery were evaluated with intraoperative SEP and MDS, and the clips were repositioned according to the findings of MDS and SEP. Patients were reexamined with digital subtraction angiography (DSA) after operation,and were evaluated with Glasgow outcome scale (GOS) one month after operation. Results There was no persistent change of SEP in all patients during surgical procedure.Aneurysms were distinguished from parent arteries in 9 (17．0％) patients by MDS. Persistent blood flow through the aneurysmal sac was revealed in 3 (5.3％) aneurysms after clipping, and the clips were repositioned. Parent artery stenosis after clipping was indicated by MDS in 6 (11.3%) cases, and the clips were repositioned. DSA revealed that there was no aneurysmal residue and stenosis of parent and adjacent vessels in 50 patients, which was in line with the findings by SEP and MDS during operation. Patients were followed up 1 month after operation, two patients died, and the other patients had 5 points (41 patients), 4 points (8 patients), 3 points (1 patient) and 2 points (1 patient) of GOS respectively. Conclusion Application of intraoperative SEP combined with MDS is a noninvasive, convenient and effective technique in intracranial aneurysm clipping surgery, which may help to improve the surgical outcomes.

Key words: somatosensory evoked potential, microvascular Doppler sonography, intraoperative monitoring, aneurysm, clipping