Estudio Preliminar sobre la Aplicación de la Monitorización Combinada de Neuroelectrofisiología- Presión Intracraneal-Presión de Perfusión Cerebral en Craneotomía para Clipaje de Aneurisma Intracraneal: Un Estudio Anatómico y Clínico

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Qiang Li; Yuhao He; Chunmiao Wu; Shengming Liu & Sunfu Zhang


Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P<0.05). At 1 day after operation, in monitoring group, GCS score was remarkably higher while NIHSS score was lower than that of control (P<0.05). At 3 months of postoperative follow-up, 5 cases were lost to follow-up in control group and 4 cases were lost in monitoring group. Excellent and good rate of GOS grading in control group was 89.65 % (52/58), and 93.22 % (55/58) in monitoring group. In addition, the excellent and good rate of mRS grading in control group was 91.38 % (53/58), and 94.92 % (56/58) in monitoring group, there was no remarkable difference in the excellent and good rate of GOS and mRS grading between the two groups at 3 months after operation (P>0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

KEY WORDS: Neuroelectrophysiology; Intracranial pressure; Cerebral perfusion pressure; Neurosurgical clipping.

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LI, Q.; HE, Y.; WU, C.; LIU, S. & ZHANG, S. Preliminary study on application of combined monitoring of neuroelectrophysiology- intracranial pressure-cerebral perfusion pressure in craniotomy for intracranial aneurysm clipping: An anatomical and clinical study. Int. J. Morphol., 42(2):348-355, 2024.