Abstract：
OBJECTIVE: To evaluate the diagnostic accuracy of intraoperative neurophysiological monitoring (IONM) during endovascular treatment (EVT) of ruptured intracranial aneurysms (rIA).
METHODS: IONM and clinical data from 323 patients who underwent EVT for rIA from 2014-2019 were retrospectively reviewed. Significant IONM changes and outcomes were evaluated based on visual review of data and clinical documentation.
RESULTS: Of the 323 patients undergoing EVT, significant IONM changes were noted in 30 patients (9.29%) and 46 (14.24%) experienced postprocedural neurological deficits (PPND). 22 out of 30 (73.33%) patients who had significant IONM changes experienced PPND. Univariable analysis showed changes in somatosensory evoked potential (SSEP) and electroencephalogram (EEG) were associated with PPND (p-values: <0.001 and <0.001, retrospectively). Multivariable analysis showed that IONM changes were significantly associated with PPND (Odd ratio (OR) 20.18 (95%CI:7.40-55.03, p-value: <0.001)). Simultaneous changes in both IONM modalities had specificity of 98.9% (95% CI: 97.1%-99.7%). While sensitivity when either modality had a change was 47.8% (95% CI: 33.9%-62.0%) to predict PPND.
CONCLUSIONS: Significant IONM changes during EVT for rIA are associated with an increased risk of PPND.
CONCLUSIONS: IONM can be used confidently as a real time neurophysiological diagnostic guide for impending neurological deficits during EVT treatment of rIA.
METHODS: IONM and clinical data from 323 patients who underwent EVT for rIA from 2014-2019 were retrospectively reviewed. Significant IONM changes and outcomes were evaluated based on visual review of data and clinical documentation.
RESULTS: Of the 323 patients undergoing EVT, significant IONM changes were noted in 30 patients (9.29%) and 46 (14.24%) experienced postprocedural neurological deficits (PPND). 22 out of 30 (73.33%) patients who had significant IONM changes experienced PPND. Univariable analysis showed changes in somatosensory evoked potential (SSEP) and electroencephalogram (EEG) were associated with PPND (p-values: <0.001 and <0.001, retrospectively). Multivariable analysis showed that IONM changes were significantly associated with PPND (Odd ratio (OR) 20.18 (95%CI:7.40-55.03, p-value: <0.001)). Simultaneous changes in both IONM modalities had specificity of 98.9% (95% CI: 97.1%-99.7%). While sensitivity when either modality had a change was 47.8% (95% CI: 33.9%-62.0%) to predict PPND.
CONCLUSIONS: Significant IONM changes during EVT for rIA are associated with an increased risk of PPND.
CONCLUSIONS: IONM can be used confidently as a real time neurophysiological diagnostic guide for impending neurological deficits during EVT treatment of rIA.
摘要：
目的：评估颅内动脉瘤破裂血管内治疗（EVT）术中神经生理监测（IONM）的诊断准确性。
方法：对2014-2019年323例接受EVT治疗的患者IONM和临床资料进行回顾性分析。基于对数据和临床文档的视觉回顾来评估显著的IONM变化和结果。
结果：在323例接受EVT的患者中，30例(9.29%)和46例(14.24%)患者出现术后神经功能缺损(PPND)的IONM显著改变.有显著IONM变化的30例患者中有22例(73.33%)出现PPND。单变量分析表明，体感诱发电位（SSEP）和脑电图（EEG）的变化与PPND相关（p值：<0.001和<0.001，回顾性分析）。多变量分析显示IONM变化与PPND显著相关(奇数比(OR)20.18(95CI:7.40-55.03,p值:<0.001))。两种IONM模式同时改变的特异性为98.9%(95%CI:97.1%-99.7%)。而当任一方式发生改变时，预测PPND的敏感性为47.8%(95%CI:33.9%-62.0%)。
结论：rIAEVT期间IONM的显著变化与PPND风险增加相关。
结论：IONM可以自信地用作EVT治疗rIA期间即将出现的神经功能缺损的实时神经生理学诊断指南。
方法：对2014-2019年323例接受EVT治疗的患者IONM和临床资料进行回顾性分析。基于对数据和临床文档的视觉回顾来评估显著的IONM变化和结果。
结果：在323例接受EVT的患者中，30例(9.29%)和46例(14.24%)患者出现术后神经功能缺损(PPND)的IONM显著改变.有显著IONM变化的30例患者中有22例(73.33%)出现PPND。单变量分析表明，体感诱发电位（SSEP）和脑电图（EEG）的变化与PPND相关（p值：<0.001和<0.001，回顾性分析）。多变量分析显示IONM变化与PPND显著相关(奇数比(OR)20.18(95CI:7.40-55.03,p值:<0.001))。两种IONM模式同时改变的特异性为98.9%(95%CI:97.1%-99.7%)。而当任一方式发生改变时，预测PPND的敏感性为47.8%(95%CI:33.9%-62.0%)。
结论：rIAEVT期间IONM的显著变化与PPND风险增加相关。
结论：IONM可以自信地用作EVT治疗rIA期间即将出现的神经功能缺损的实时神经生理学诊断指南。
