| BackgroundSurgical clipping of aneurysms is one of the main methods to treat intracranial aneurysms.Premature rupture and hemorrhage of aneurysms are very common in intracranial aneurysm clamping,and there is a fatal risk when intracranial aneurysms occur.Ruptured aneurysms,large or giant aneurysms,especially before surgery,are at higher risk of rupture.In order to reduce the internal pressure and reduce the tension of the aneurysm,the temporary blocking technique of the bearing artery in the operation can be used to reduce the pressure and tension of the aneurysm,so as to facilitate the safe clamping of the aneurysm by the operator.In addition,for incision tumor body,remove tumor neck calcification,atherosclerotic plaque also very advantageous.Yes However,temporary arterial occlusion can reduce the rate of aneurysm rupture and lead to cerebral ischemia or even infarction in the corresponding donor region.Therefore,the safe time limit for temporary occlusion of tumor-bearing arteries is particularly important.Combined with neuroelectrophysiological technique,the possible ischemic damage of brain tissue can be detected early during the operation,which is of high warning significance to the main knife surgeon during the temporary occlusion of the bearing tumor artery.However,there are different reports about the safety time limit of temporary cerebral artery occlusion.ObjectiveThe safety time limit of temporary occlusion of middle cerebral artery was evaluated objectively under continuous monitoring of neuroelectrophysiology during operation..MethodsWith the approval of the Medical Ethics Committee,204 patients with intracranial aneurysms were collected from the Department of Neurosurgery,the first affiliated Hospital of Xinxiang Medical College from October 2016 to May 2017.Finally,51 patients were included in this study according to the criteria of inclusion and exclusion.Inclusion criteria: 1.After detailed communication with the patient and / or family members,according to the principle of informed consent,choose whether to perform craniotomy;2.According to the voluntary principle of patient and / or family members to choose whether or not to perform neuroelectrophysiological monitoring technique during the operation;3.After admission,the patients with intracranial aneurysms were confirmed and diagnosed according to their clinical manifestations,signs and auxiliary examinations.;4.Preoperative imaging and intraoperative findings of middle cerebral artery segment aneurysms;5.The preoperative Hunt-Hess grade was between I-IV grades;6.Patients without severe heart,liver,kidney and other organic lesions and comprehensive evaluation of tolerance to surgery and anesthesia.7.The patient is awake after operation and can be instructed to have the ability of autonomous activity;8.The patients were followed up regularly for 6 months.Exclusion criteria: 1.The patient and / or his / her family members still refuse to require conservative treatment after being admitted to the hospital after communicating their condition;2.Patients and / or family members choose aneurysm embolization with informed consent;3.Intracranial aneurysm is non-cerebral Patients with middle aneurysm;4.After admission,(SAH),was conformed to subarachnoid hemorrhage,but after CTA or whole cerebral angiography,SAH was found to be caused by rupture and hemorrhage of non-intracranial aneurysm.Patients with Hunt-Hess grade V after admission;5.Previous complications,such as severe cardio-pulmonary diseases,could not tolerate the risk of surgery and anesthesia;7.A person who dies within six months of the onset of the disease;8.The patient left hospital after operation and lost follow-up;9.After admission,the patient had undergone endovascular embolization,and then underwent craniotomy again due to other conditions;10.5% of the patients had undergone craniotomy.Patients with a previous history of severe stroke and severe neurological dysfunction were left with a history of cerebral apoplexy.Consult patients in detail The basic information of patients who met the above screening criteria were retrospectively analyzed: age,previous history,location of aneurysm,size of aneurysm,Hunt-Hess grade,intraoperative neuroelectrophysiological monitoring,and so on,which included age,previous history,location of aneurysm,size of aneurysm,Hunt-Hess grade and neuroelectrophysiological monitoring during operation.Preoperative and postoperative physical examination and imaging findings.CT and CTA were performed on day 1 and 3 after operation to block the low density changes in the blood supply area as an imaging ischemic event in order to block the changes of low density in the blood supply area of the blood vessels during the first 3 days after the operation.Before and after the operation,on the same day,the next day,the third day,one week and six months after the operation,the patients' consciousness level,sensation and limb muscle strength were examined respectively,in order to decrease the nerve function in the blood supply blocking area after operation.The postoperative muscle strength of one or more limbs decreased by ? 1 grade compared with that before operation,which was a clinical ischemic event.Through univariate analysis and Logistic regression analysis of the related factors of postoperative ischemic events,the related factors of postoperative ischemic events and the safe time limit of temporary arterial occlusion were obtained.ResultsAll 51 patients(56 aneurysms)were completely occluded,5 patients(9.8%)had obvious changes in neuroelectrophysiological monitoring index during operation,among them,2 patients were treated with timely intervention during the operation,and 5 patients(9.8%)had obvious changes in neuroelectrophysiological monitoring index during the operation.Before the end of the operation,the monitoring parameters returned to baseline level,but the other 3 patients,until the end of the operation,the neuroelectrophysiological monitoring waveform was still not fully restored to the baseline level,and related ischemic events occurred after the operation.The temporary arterial occlusion time of the 3 patients with ischemic events was above 8min,while that of the 48 patients without ischemic events was above 8 in all the 48 patients who had no ischemic events during the operation.3 patients with ischemic events had a temporary arterial occlusion time of more than 8.Below min.The analysis of general data showed that there was no correlation between postoperative ischemic events and sex,age,Hunt-Hess grade,diabetes and residence.,but the temporary occlusion time of tumor-carrying artery was related to the incidence of ischemic events.Multivariate Logistic regression analysis showed that temporary occlusion time of tumor-carrying artery ? 8min was an independent risk factor for ischemic events after operation.Conclusion(1)Intraoperative electrophysiological monitoring has a high warning effect on ischemic events associated with temporary occlusion of the bearing artery.(2)Under the condition of normal temperature and normal pressure,the safety time of temporary occlusion of middle cerebral artery during inferior aneurysm occlusion was 8 minutes. |
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