Application neurophysiological monitoring during one-stage surgical clipping for multiple intracranial aneurysms

LIANG Yu-hong; ZHANG Wen-fang; CHEN Feng; ZHOU Yi; PENG Peng; Hu Ke-qi

doi:10.13798/j.issn.1009-153X.2024.01.005

Abstract：Objective To investigate the application value of neuroelectrophysiological monitoring(NPM)in one-stage surgical clipping for patients with multiple intracranial aneurysms(MIA).Methods The clinical data of 30 MIA patients underwent one-stage surgical clipping under guidance NPM from January 2018 to June 2022 were retrospectively analyzed.Preoperative brain CT scan,CTA and/or DSA were performed to confirm the diagnosis.During the operation,somatosensory evoked potential(SEP),motor evoked potential(MEP),brainstem auditory evoked potential(BAEP)and electroencephalogram(EEG)were dynamically monitored.Results A total of 69 aneurysms were found in 30 patients,of whom 23 had 2 aneurysms,5 had 3 aneurysms,and 2 had 4 aneurysms.There were 11 aneurysms with a diameter<0.5 cm,28 aneurysms with a diameter of 0.5～1.5 cm,25 aneurysms with a diameter of 1.5～2.5 cm,and 5 aneurysms with a diameter≥2.5 cm.Postoperative CTA showed that all aneurysms of 30 patients were completely clipped,and the parent arteries were patency.NPM parameters were normal in 25 patients and abnormial in 5 patients,of whom the NPM parameters returned to normal in 3 patients and did not in 2 after treatment,during the temporary blockade of parent arteries.Three months after operation,2 patients with normal NPM parameters had limb motor dysfunction with a GOS score of 3 and 4,respetively.Of the other 28 patients,4 patients had a GOS score of 3,6 patients of 4,and 18 patients of 5.Conclusions During the one-stage surgical clipping for patients with MIA,the intraoperative NPM technique has an early warning effect on related ischemic events,and timely treatment can avoid and reduce nerve function injury caused by operation.