Impact of intraoperative neurophysiological monitoring and anesthesia management parameters on postoperative recovery in patients undergoing complex intracranial aneurysm surgery

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-09-24 DOI:10.1016/j.jocn.2025.111631

Dabao Wang , Junwei Tong , Buxing Liu , Ye Li , Xia Zhang

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引用次数: 0

Abstract

Background

Complex intracranial aneurysms (CIAs) pose significant challenges in neurosurgery, with postoperative neurological deficits (PNDs) being a major concern. This study aimed to evaluate the combined impact of intraoperative neurophysiological monitoring (IONM) and standardized anesthesia management on postoperative recovery in patients undergoing microsurgical clipping for CIAs.

Methods

A retrospective analysis of 106 patients with CIA (April 2022–March 2025) was conducted. Patients were divided into a non-IONM group (n = 45) and an IONM group (n = 61) receiving standardized total intravenous anesthesia with strict hemodynamic/temperature control. Neurological (National Institutes of Health Stroke Scale, NIHSS), cognitive (Mini-Mental State Examination, MMSE), and functional (Modified Rankin Scale, mRS) outcomes were assessed preoperatively and at 24 h, 7 days, and 1 month postoperatively. Additionally, IONM parameters and anesthesia variables were analyzed for associations with poor recovery.

Results

The IONM group exhibited significantly better NIHSS scores (24 h: 18.47 ± 3.02 vs. 19.83 ± 3.27, P = 0.029; 7d: 13.25 ± 2.58 vs. 15.04 ± 3.76, P = 0.007) and MMSE scores (24 h: 27.14 ± 2.12 vs. 26.16 ± 1.93, P = 0.016; 7d: 28.63 ± 1.13 vs. 27.94 ± 1.21, P = 0.003), lower PND incidence (9.84 % vs. 31.11 %, P = 0.006), and more favorable mRS distributions than the non-IONM group. Poor recovery was strongly associated with irreversible IONM changes (OR = 6.06–9.04, P < 0.05) and increased intraoperative MAP/HR/temperature fluctuations (OR = 1.33–10.08 per unit, P < 0.05).

Conclusion

Integrating multimodal IONM with rigorous anesthesia parameter optimization significantly enhances early neurological and cognitive recovery while reducing deficits in CIA surgery. IONM alerts and physiological instability are interdependent risk amplifiers, underscoring the need for protocolized integration of real-time neural pathway surveillance and hemodynamic/thermal homeostasis as a unified neuroprotective strategy in high-risk neurovascular procedures.

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术中神经生理监测及麻醉管理参数对复杂颅内动脉瘤术后恢复的影响

复杂颅内动脉瘤（CIAs）是神经外科的重大挑战，术后神经功能缺损（pnd）是一个主要问题。本研究旨在评估术中神经生理监测（IONM）和标准化麻醉管理对微创夹闭cia患者术后恢复的影响。方法对106例CIA患者（2022年4月~ 2025年3月）进行回顾性分析。患者分为非IONM组（n = 45）和IONM组（n = 61），接受标准化静脉全麻醉，严格控制血流动力学/温度。术前、术后24小时、7天和1个月分别评估神经学（美国国立卫生研究院卒中量表，NIHSS）、认知学（简易精神状态检查，MMSE）和功能学（改良Rankin量表，mRS）结果。此外，还分析了IONM参数和麻醉变量与不良恢复的关系。结果IONM组NIHSS评分（24 h: 18.47±3.02 vs. 19.83±3.27,P = 0.029; 7d: 13.25±2.58 vs. 15.04±3.76,P = 0.007）和MMSE评分（24 h: 27.14±2.12 vs. 26.16±1.93,P = 0.016; 7d: 28.63±1.13 vs. 27.94±1.21,P = 0.003）明显优于非IONM组，PND发生率较低（9.84% vs. 31.11%, P = 0.006）， mRS分布优于非IONM组。恢复不良与不可逆的IONM变化（OR = 6.06-9.04, P < 0.05）和术中MAP/HR/温度波动增加（OR = 1.33-10.08 /单位，P < 0.05）密切相关。结论将多模态IONM与严格的麻醉参数优化相结合，可显著提高CIA手术早期神经和认知功能的恢复，减少手术缺陷。IONM警报和生理不稳定是相互依赖的风险放大器，强调需要将实时神经通路监测和血流动力学/热稳态作为高风险神经血管手术中统一的神经保护策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.