Abstract：
Intraoperative neurophysiological monitoring (IONM) is a technique used to assess the somatosensory and gross motor systems during surgery. While it is primarily used to detect and prevent surgically induced nervous system trauma, it can also detect and prevent injury to the nervous system that is the result of other causes such as trauma or ischemia that occur outside of the operative field as a result of malpositioning or other problematic physiologic states. We present a case study where a neuromonitoring alert altered the surgical procedure, though the alert was not correlated to the site of surgery. A 69-year-old male with a history of bilateral moyamoya disease and a left middle cerebral artery infarct underwent a right-sided STA-MCA bypass and encephaloduroarteriosynangiosis (EDAS) with multimodal IONM. During the procedure, the patient experienced a loss of motor evoked potential (MEP) recordings in the right lower extremity. Blood pressure was elevated, which temporarily restored the potentials, but they were lost again after the angiography team attempted to place an arterial line in the right femoral artery. The operation was truncated out of concern for left hemispheric ischemia, and it was later discovered that the patient had an acute right external iliac artery occlusion caused by a fresh thrombus in the common femoral artery causing complete paralysis of the limb. This case highlights the importance of heeding IONM alerts and evaluating for systemic causes if the alert is not thought to be of surgical etiology. IONM can detect adverse systemic neurological sequelae that is not necessarily surgically induced.
摘要：
术中神经生理监测（IONM）是一种用于评估手术过程中体感和粗大运动系统的技术。虽然它主要用于检测和预防手术引起的神经系统创伤，它还可以检测和防止神经系统损伤，这是其他原因的结果，如创伤或局部缺血，发生在手术领域之外，由于错位或其他有问题的生理状态。我们提供了一个案例研究，其中神经监测警报改变了手术程序，尽管警报与手术部位无关。一名69岁的男性，有双侧烟雾病和左大脑中动脉梗塞的病史，接受了右侧STA-MCA旁路术和脑性动脉合管症（EDAS）的多模式IONM。在手术过程中,患者在右下肢出现运动诱发电位(MEP)记录丢失.血压升高,暂时恢复了潜力，但在血管造影小组试图在右股动脉中放置动脉线后，他们再次丢失。手术因左半球缺血而被截断，后来发现该患者患有急性右髂外动脉闭塞，这是由于股总动脉中的新鲜血栓引起的，导致肢体完全瘫痪。这种情况突出了注意IONM警报和评估系统性原因的重要性，如果警报不被认为是手术病因。IONM可以检测不一定是手术诱导的不良系统性神经后遗症。
