Usefulness of Endoscopy, Motor Evoked Potential Monitoring, and Navigation for Safe and Accurate Clipping of Cerebral Aneurysmsстатья из журнала
Аннотация: We evaluated the usefulness of endoscopy, motor evoked potential (MEP) monitoring, and navigation for safe and accurate clipping of cerebral aneurysms. Of 116 patients (ruptured, 50; unruptured, 66) who underwent surgical procedures from January 2000 to September 2005 at our hospital, endoscope-assisted surgery was performed in 50 operations (ruptured, 17; unruptured, 33), MEP monitoring was done in 6 operations (unruptured, 6), and a navigation system was used in 6 operations (ruptured, 1; unruptured, 5). Endoscope-assisted surgery was performed using a 2.7- or 4-mm-diameter endoscope with a tip angle of 30º or 70º. The Stealth Station was used as the navigation system. MEP monitoring was performed using electrical stimulation of the motor cortex and EMG recording of the face, trunk, and the upper and lower extremities contralateral to the stimulated side. During endoscope-assisted surgery, the anatomical relationship between the aneurysm neck and the parent artery or perforating artery could be observed before clipping, and the location of the clip tip, occlusion of the perforating artery, or stenosis of the parent artery could be evaluated after clipping. Among the 28 patients whose perforating artery was observed endoscopically, 3 were re-clipped due to suspicion of perforating artery occlusion or stenosis. On postoperative MR and/or CT images, perforating artery infarctions were observed in 4 patients, although none were symptomatic. Although MEP monitoring was expected to predict the postoperative motor function, fortunately, no patients showed abnormal MEP findings after aneurismal neck clipping. Navigation allowed the prediction of the site of aneurysm and parent artery before dissection, resulting in an accurate approach to these structures. Endoscopy, MEP monitoring, and navigation are considered useful for performing safe and accurate clipping of cerebral aneurysms.
Год издания: 2007
Авторы: Yoshiaki Kumon, Shinji Iwata, Shigeyuki Nagato, Hideaki Watanabe, Keiji Igase, Shiro Ohue, Takanori Ohnishi
Издательство: Japanese Society on Surgery for Cerebral Stroke
Источник: Surgery for Cerebral Stroke
Ключевые слова: Intraoperative Neuromonitoring and Anesthetic Effects, Intracranial Aneurysms: Treatment and Complications, Vascular Malformations Diagnosis and Treatment
Открытый доступ: bronze
Том: 35
Выпуск: 6
Страницы: 417–422