Fenghua Li, Eric Deshaies, Geoffrey Allott, Reza Gorji
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引用次数: 0
摘要
脑运动诱发电位(MEP)监测在动静脉畸形(AVM)栓塞期间没有得到很好的研究(Söderman et al. 2003)。脑栓塞过程中脑血流量的改变可引起大脑皮层缺血/梗死。永久性mep缺失与永久性运动缺陷相关。我们报告了一例接受AVM栓塞的患者,在此期间,经颅电运动诱发电位(TCeMEP)可靠地预测了选择性甲氧六酮试验引起的CBF变化。我们的研究结果表明,mep是术中监测运动通路完整性和预测变化的有用手段。MEP的丧失预测并预防了严重的术后运动功能障碍。术中神经监测SSEP、TCeMEP和连续脑电图显示,直到注射大脑后动脉(PCA),而大脑前动脉(ACA)未见变化。TCeMEP在预测AVM手术中运动损伤方面可能优于体感诱发电位(SSEP)和脑电图监测。
Transcranial motor evoked potential changes induced by provocative testing during embolization of cerebral arteriovenous malformations in patients under total intravenous anesthesia.
Cerebral motor evoked potential (MEP) monitoring during arteriovenous malformation (AVM) embolization is not well studied (Söderman et al. 2003). Alterations of cerebral blood flow (CBF) during cerebral embolization could cause ischemia/infarction to the cerebral cortex. Permanent loss of MEPs is correlated with a permanent motor deficit. We report a case of a patient undergoing AVM embolization during which transcranial electrical motor evoked potentials (TCeMEP) reliably predicted changes to CBF induced by selective methohexital testing. Our finding demonstrated that MEPs are a useful means of intraoperative monitoring of motor pathway integrity and predicting changes. The loss of MEP predicted and prevented severe postoperative motor deficits. Intraoperative neuromonitoring with SSEP, TCeMEP and continuous EEG revealed no changes until the posterior cerebral artery (PCA), but not the anterior cerebral artery (ACA), was injected. TCeMEP may be superior to somatosensory evoked potential (SSEP) and EEG monitoring in predicting motor impairment during AVM surgery.