Features of intraoperative neurophysiological monitoring and perioperative ultrasonic transcranial duplex scanning in patients with delayed cerebral ischemia after clipping of ruptured arterial aneurysms

AIM OF THE STUDY: to study the dynamics of perioperative transcranial Doppler ultrasonography (tcD) in patients with aneurysmal subarachnoid hemorrhage (asah) with various clinical outcomes, in whom transient significant changes of responses (tscr) were registered according to intraoperative neurophysiological monitoring (IOnm), during aneurysm clipping.
METHODS: 56 patients with aSAh, 24 men and 32 women were included, who underwent aneurysm clipping with IONm. Patients were divided into three groups:
With an increase in neurological deficit (ND) due to delayed cerebral ischemia (DCI), with TSCR according to IONm — 7 people.
Without an increase in ND, with a TSCR according to IONm — 19 people. The control group without an increase in ND, and without TSCR according to IONm — 30 people.
RESULTS. There was a significant increase in peak systolic blood flow velocity (PSbFV) in the middle cerebral artery (mCA) after surgery in group 1 (before surgery 111.9 ± 47.6 cm/s, after — 196.5 ± 74.5 cm/s, p = 0.001), and in group 2 (before — 108.6 ± 20.3 cm/s, after — 158.0 ± 66.9, p<0.001), as well as the Lindegaard index (LI) in group 1 (before — 2,5 ± 0.7, after — 3.5 ± 1.1, p = 0.01), and in group 2 (before — 2.1 ± 0.3, after — 2.9 ± 1.1, p<0.001). At the same time, in group 3, the increase of PSbFV in mCA and IL after surgery was not significant (before — 130.5 ± 45.8 cm/s, after — 141.4 ± 48.9 cm/s, p>0.05). PSbFV in the mCA before surgery was significantly higher than in groups 1 and 2.
CONCLUSION. TSCR according to IONm can be a marker of a decrease in cerebrovascular reserve and one of the risk factors for the development of DCI.

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