Chinese expert consensus on neurophysiologic monitoring during extracranial-intracranial bypass surgery (2024 edition)

doi:10.3877/cma.j.issn.2095-123X.2024.02.001

Abstract

Abstract:

Extracranial-intracranial (EC-IC) bypass surgery is a commonly used technique in neurosurgery, but abnormal perfusion caused by surgical operation can lead to postoperative complications such as new-onset cerebral ischemia and neurological dysfunction, which seriously affects the prognosis of patients. Intraoperative neurophysiological monitoring (IONM) can effectively identify early intraoperative ischemia, reduce surgical complications, and assess the improvement of cerebral perfusion after the establishment of EC-IC bypass. However, no relevant norms or consensus have been developed around the world. Based on the review of reported clinical evidence, our team developed this expert consensus after Delphi expert consultation, forming a consensus on 5 aspects: the significance of IONM for EC-IC bypass surgery, the method of IONM for EC-IC bypass surgery, indications and contraindications for IONM for EC-IC bypass surgery, the monitoring strategy and interpretation of IONM results for EC-IC bypass surgery in different diseases, and other notes. Based on the GRADE evidence level standard, this expert consensus combines the national expert opinions on neurophysiology and EC-IC bypass to give eight comments on the clinical practice of IONM for EC-IC bypass surgery.

Key words: Extracranial-intracranial bypass surgery, Ischaemic cerebrovascular disease, Intraoperative neurophysiological monitoring, Complex aneurysms, Expert consensus

Neurophysiological Monitoring Group of the Chinese Medical Doctor Association Neurosurgery Branch, Clinical Neurophysiology Committee of the Chinese Research Hospital Association. Chinese expert consensus on neurophysiologic monitoring during extracranial-intracranial bypass surgery (2024 edition)[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(02): 65-72.

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References 47

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分级	具体描述
证据质量等级
高（A）	对观察值非常有把握：观察值接近真实值
中（B）	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论质量高低的证据均显示利弊相当

分级	具体描述
证据质量等级
高（A）	对观察值非常有把握：观察值接近真实值
中（B）	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度分级
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论质量高低的证据均显示利弊相当

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