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Neurological Surgery No Shinkei Geka Volume 19, Issue 4 （April 1991）

Neurological Surgery 脳神経外科 19巻4号（1991年4月発行）

Japanese English

研究

椎骨脳底動脈瘤とSEPモニタリング—術中操作時ならびに脳主幹動脈閉塞時における有用性について SEP Monitoring during Balloon Occlusion Test or Operation for Vertebro-basilar Aneurysms 黒田敏 ¹ , 米川泰弘 ¹ , 河野輝昭 ¹ , 山下耕助 ¹ , 半田寛 ¹ , 後藤泰伸 ¹ , 田中公人 ¹ , 郭泰彦 ¹ , 滝和郎 ² Satoshi KURODA ¹ , Yasuhiro YONEKAWA ¹ , Teruaki KAWANO ¹ , Kousuke YAMASHITA ¹ , Hiroshi HANDA ¹ , Yasunobu GOTOH ¹ , Kimihito TANAKA ¹ , Yasuhiko KAKU ¹ , Waro TAKI ² ¹国立循環器病センター脳神経外科 ²京都大学脳神経外科 ¹Department of Neurosurgery, National Cardiovascular Center ²Department of Neurosurgery, Kyoto University School of Medicine キーワード： Cerebral aneurysm , Vertebral artery , Basilar artery , Monitoring , Somatosensory evoked potential Keyword: Cerebral aneurysm , Vertebral artery , Basilar artery , Monitoring , Somatosensory evoked potential pp.343-348

発行日 1991年4月10日 Published Date 1991/4/10

DOI https://doi.org/10.11477/mf.1436900243

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Abstract 文献概要
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I．はじめに

　Somatosensory evoked potential（SEP）を用いた脳動脈瘤手術中のモニタリングは，術中の脳虚血によるmorbidityを減少させるために，主として内頸動脈系の動脈瘤の手術において行なわれ，現在まで多くの報告がされている^{2-5,11-13,17-19,22-24,26）}．しかし，椎骨脳底動脈瘤の術中における電気生理学的モニタリングの報告はいまだに限られており，その有用性に関しても確立されていない^5,15,16）．

　われわれは椎骨脳底動脈系の動脈瘤の術中，または，覚醒下におけるballoon occlusion testの際にSEPによるモニタリングを行ない，その有用性を検討したので報告する．

Abstract

SEP (somatosensory evoked potential) monitoring was carried out on seven patients with vertebro-basilar aneurysms during balloon occlusion test, during opera-tion, or after operation. In the patient (case 5) withbasilar tip aneurysm, the amplitude of N20 remarkably decreased and this finding closely correlated with dis-turbed consciousness during transient balloon occlusion of the basilar artery. In another patient (case 6) with verterbral dissecting aneurysm, cerebellar retraction caused transient prolongation of N20 latency during op-eration. In another case, postoperative SEP monitoring revealed marked reduction of N20 amplitude in the pa-tient (case 7) who showed disturbed consciousness and bilateral oculomotor palsy after operation for basilar aneurysms, but who showed no abnormality in postop-erative ABR (auditory evoked brainstem response). The other four patients showed no neurological deterio-ration and no SEP change during transient balloon occlusion of the parent arteries.

Because of the high rate of “false-negative” findings, it remains unclear whether SEP monitoring during surgery for vertebrobasilar aneurysms is of value to predict postoperative deficit due to brainstem ischemia. In our study, however, the changes of SEP were well correlated with neurological deterioration and / or the location of postoperative infarction.

In conclusion, SEP monitoring during balloon occlu-sion tests or operations for vertebro-basilar aneurysms is considered to be useful in predicting ischemic compli-cation of the brainstem caused by the occlusion of the parent artery. However other methodologies have to be developed in order to monitor the pyramidal tract and reticular activating system of the brainstem more accu-rately.