摘要目的 研究颅内动脉瘤术中应用皮层电极进行皮层脑电图(EEG)和皮层运动诱发电位(MEP)监测的价值和意义.方法 42例颅内动脉瘤患者,翼点开颅夹闭动脉瘤术中常规行头皮EEG、体感诱发电位(SEP)、MEP和皮层EEG、MEP监测,将监测变化结果与术后神经功能做前瞻性研究.结果 36例可诱发出皮层MEP,8例监测出现了变化,其中SEP 4例、皮层EEG 6例、头皮EEG 2例、皮层MEP 7例、头皮MEP 5例.皮层MEP出现变化的6例非大脑前动脉系统动脉瘤中仅3例头皮MEP出现了变化.结论 皮层MEP所需刺激量小,较适合于非大脑前动脉动脉瘤的术中监测,其敏感性高于头皮MEP.皮层EEG监测的敏感性明显高于头皮EEG.

abstractsObjective To study the value and significance of cortical electroencephalogram (EEG)and direct cortical motor evoked potentials (MEP) monitoring in intracranial aneurysm surgery.Methods Scalp EEG,SEP,MEP and cortical EEG,MEP were monitored during surgical management of intracranial aneurysms by pterional craniotomy in forty-two patients.Monitoring results ,clinical outcomes and their correlation were prospectively analyzed.Results Cortical MEP could be elicited in thirty-six patients intraoperatively.Cortical MEP could not be induced in five patients with anterior cerebral artery system aneurysms and one patient with non-anterior cerebral artery system aneurysm.Changes of intraoperative monitoring results occurred in eight patients,including SEP in four cases,cortical EEG in six cases,scalp EEG in two cases,cortical MEP in seven cases and scalp MEP in five cases.Among the six patients with non-anterior cerebral artery system aneurysms and showing changed cortical MEP,only three of them presented changes in scalp MEP.Scalp EEG had significant change during surgery in two patients,who suffered severe intraoperative ischemia.For those patients whose evoked potentials could be elicited before the end of operation,their neurological function recovered well after operation.Conclusions Cortical MEP need small volume of stimulus and it is more suitable to be applied in intraoperative monitoring during surgery for middle cerebral artery,internal carotid artery and posterior communicating artery aneurysrns.Its sensitivity is higher than that of scalp MEP.The sensitivity of cortical EEG monitoring is superior to that of scalp EEG.