在颅内动脉瘤线圈栓塞术中应用体感诱发电位监测早期检测造影剂诱导的脑病。

Journal of neuroendovascular therapy Pub Date : 2025-01-01 Epub Date: 2025-06-28 DOI:10.5797/jnet.cr.2025-0039
Ken Takahashi, Toshiyuki Onda, Yoshinori Kurauchi, Shigeru Inamura, Masayoshi Takigami, Masahiko Daibou, Tadashi Nonaka
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引用次数: 0

摘要

目的:对比剂诱发的脑病(CIE)是一种罕见的血管内手术并发症,其病理生理机制尚不完全清楚。在全身麻醉下术中发现它是具有挑战性的。我们报告了一例动脉瘤栓塞期间发生的CIE,在不同的手术过程中表现出不同的严重程度,并表明体感诱发电位(SEPs)可能有助于早期识别。病例介绍:一名63岁女性在全身麻醉下行血管内线圈栓塞治疗脑前远端动脉瘤破裂,术中经颅SEP监测。在手术过程中,颈内动脉注射造影剂引起短暂的SEP衰减,导致患者术后轻度轻瘫和感觉障碍,这两种情况在几天内消失。6个月后,颈总动脉DSA证实颈圈压实。患者接受了检查,未发现出现神经系统症状的迹象。次月再次栓塞。在第二次手术中,从ICA的C1节段注射造影剂导致左下肢SEP完全丧失。手术后,患者立即表现出轻度左下肢轻瘫和感觉障碍。术后立即锥形束CT显示右半球增强,诊断为CIE。第二天,患者出现左半球忽视,同时左偏瘫和感觉障碍加重,尽管MRI未见明显异常。这些缺陷在类固醇治疗后得到改善,并在第6天得到解决。结论:术中SEP监测有助于动脉瘤栓塞术中CIE的早期发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early Detection of Contrast-Induced Encephalopathy Using Somatosensory Evoked Potential Monitoring during Coil Embolization of an Intracranial Aneurysm.

Objective: Contrast-induced encephalopathy (CIE) is a rare complication of endovascular procedures with an incompletely understood pathophysiology. Its intraoperative detection under general anesthesia can be challenging. We present a case of CIE occurring during aneurysm embolization, demonstrating varying severity across procedures and suggesting that somatosensory evoked potentials (SEPs) may help in early recognition.

Case presentation: A 63-year-old woman underwent endovascular coil embolization for a ruptured distal anterior cerebral artery aneurysm under general anesthesia, with intraoperative transcranial SEP monitoring. Contrast injection from the cervical internal carotid artery (ICA) during the procedure caused transient SEP attenuation, leading to mild post-procedural paresis and sensory impairment in the patient, both of which resolved within days. Six months later, DSA from the common carotid artery confirmed coil compaction. The patient underwent the examination and showed no signs of developing neurological symptoms. Repeat embolization was performed in the following month. During the 2nd procedure, contrast injection from the C1 segment of the ICA resulted in complete loss of left lower limb SEP. Immediately after the procedure, she exhibited mild left lower limb paresis and sensory impairment. Immediate postoperative cone-beam CT revealed contrast enhancement in the right hemisphere, leading to a diagnosis of CIE. On the following day, she developed left hemispatial neglect, along with worsening left hemiparesis and sensory impairment, despite no apparent abnormalities on MRI. The deficits improved with steroid therapy and were resolved by day 6.

Conclusion: Intraoperative SEP monitoring may be useful for the early detection of CIE during aneurysm embolization.

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