ICGA combined with EP monitoring in microclipping of cerebral aneurysms

Abstract

Objective Cerebral aneurysm is one of the common cerebrovascular diseases in neurosurgery, and rupture of cerebral aneurysm is the most important cause of spontaneous subarachnoid hemorrhage. How to precisely clip the aneurysm has been a topic worth discussing, so the authors explore the value of ICGA combined with electrophysiological monitoring in microclipping of cerebral aneurysms.Methods Using the method of retrospective analysis of cases, 661 patients with cerebral aneurysms admitted to the Department of Neurosurgery of Wuhan University Central South Hospital from 2021.8 to 2022.10 were studied, 390 patients with aneurysm clipping were included, and patients with Hunt-Hess classification ≥ 4 were excluded, and whether to use ICGA combined with EP in microclipping of the ruptured and unruptured aneurysm in pterional approach was investigated at the time of discharge, respectively. The MRS and total hospital days were compared to investigate the value of ICGA combined with EP in microclipping of cerebral aneurysms.Results All 390 patients enrolled in the group had successful aneurysm clipping, and 178 patients were screened for ruptured aneurysm pterional approach and 120 patients for unruptured aneurysm pterional approachwing point access; the MRS at discharge was significantly lower in the ICGA combined with EP group than in the no EP group for ruptured aneurysm pterional approach microclipping (p < 0.001), and the mean number of days in hospital was significantly lower (p < 0.01). Patients in the ICGA combined with EP group in microclipping of unruptured aneurysms with pterional approach also had significantly lower MRS at discharge compared with patients in the ICGA alone group (p < 0.001), with no statistically significant difference in the mean number of days in hospital (p = 0.09).Conclusions In open cerebral aneurysm microclipping, the use of ICGA combined with EP monitoring for both ruptured and unruptured aneurysms significantly reduces the rate of misclipping of the penetrating vessels, avoids stenosis or occlusion of the aneurysm-carrying artery, effectively reduces the rate of false negative ICGA, reduces the occurrence of postoperative neurological deficits, and shortens the total hospital stay to some extent. The combination of ICGA and EP monitoring in cerebral aneurysm microclipping is worth promoting.