未破裂脳動脈瘤クリッピング術における皮質―脊髄運動誘発電位モニタリング
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概要
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Object : We reported our experiences and usefulness of cortico-spinal motor evoked potencials (MEPs) to prevent postoperative motor impairment during surgery of unruptured cerebral aneurysms. Methods : Seven patients with unruptured cerebral aneurysms underwent MEPs monitoring during surgery because their surgical procedure involved prolonged temporary occlusion of main artery or risks of injury of lenticulostriate or anterior choroidal artery. A wire electrode was inserted into the cervical epidural space before induction of general anesthesia. Subsequently, we performed a standard frontotemporal craniotomy under general anesthesia with inhalation anesthetics and muscle relaxant. After exposure of the aneurysm, central sulcus was identified with the use of somatosensory evoked potential (SEP) phase reversal and a grid electrode strip with 4 electrodes was placed on precentral gyrus. The D response evoked by bipolar stimulation with monophasic squarewave pulse was monitored during manipulation around aneurysms and clipping. Results : The MEPs were successfully recorded in six of seven patients. In one patient with an ICA-posterior communicating artery aneurysm, MEPs was disappeared after temporary occlusion of proximal ICA, but recovered by immediate release of temporary occlusion after clipping of aneurysm neck. The other patient with an MCA aneurysm, the MEPs amplitude reduced accompanied with brain retraction, but immediately recovered after the brain retraction was released. No permanent postoperative motor impairment was encountered in those patients included in this study. Conclusion : We concluded that cortico-spinal MEP was useful for monitoring motor function and prevention of motor impairment during aneurysm surgery.
- 2005-03-01
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