Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery - A review and discussion of the literature
Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery - A review and discussion of the literature
复制标题
DOI：
10.1016/j.neucli.2007.07.007
复制
发表时间：
2007-12-01
影响因子：
3
通讯作者：
Grotenhuis, J. A.
中科院分区：
文献类型：
--
作者：
Langeloo, D. -D.;Journee, H. -L.;Grotenhuis, J. A.
经颅电刺激运动诱发电位监测（TES-MEP）已被证明是脊柱矫正手术中成功可靠的神经监测技术。然而，文献中描述了TES-MEP监测的三个标准。本研究旨在探讨和比较以下标准：(1)Calancie et at提出的“阈值水平标准”。（J neurosurgery 88(1998) 457-70）：阈值水平增加超过100V，超过1小时获得有用的TES-MEP反应表明神经功能受损；(2)“振幅标准”：对于脊柱矫正手术中的TES-MEP监测，Langeloo等人认为一个或多个反应振幅下降超过80%是即将出现神经功能缺损的有价值的标准。（脊柱28 (2003)1043-50）；(3)“形态学标准”：2005年由Quinones等人提出。（神经外科56(2005)982-93），它是基于mep复合肌肉动作电位（CMAP）的形态学。该标准应用于髓内脊髓肿瘤切除术期间的TES-MEP监测。神经系统事件的定义是反应持续时间和/或波形复杂性急剧减少，电压阈值增加到100V或更高。虽然所有的方法在脊柱手术中都是成功的，但阈值标准和形态学改变标准有一些缺点。我们认为在脊柱矫正手术中，减振幅法是最有用的。在基于此标准的TES-MEP监测过程中，观察和决策的顺序用流程图表示。(c) 2007年Elsevier Masson SAS。版权所有。
Transcranial electrical stimulated motor evoked potential monitoring (TES-MEP) has proven to be a successful and reliable neuromonitoring technique during spinal correction surgery. However, three criteria for TES-MEP monitoring have been described in the literature. This study aims at discussing and comparing the following criteria: (1) the "threshold level criterion" introduced by Calancie et at. (J Neurosurg 88 (1998) 457-70): a more than 100V over more than 1 h increase of threshold Level to get useful TES-MEP responses indicated neurological impairment; (2) the "amplitude criterion": for TES-MEP monitoring in corrective surgery of the spine, a more than 80% decrease of one or more response amplitudes was considered a valuable criterion for impending neurological deficits by Langeloo et at. (Spine 28 (2003) 1043-50); (3) "the morphology criterion": introduced in 2005 by Quinones et at. (Neurosurgery 56 (2005) 982-93), it is based on the morphology of the MEP-compound muscle action potentials (CMAP). The criterion was applied during TES-MEP monitoring during intramedullary spinal cord tumour resection. Neurological events are defined by a sharp decrease of response duration and/or waveform complexity and an increase in voltage threshold of 100V or greater. Although all methods have been reported to be successful during spinal surgery, the threshold criterion and the morphology change criterion carry several drawbacks. We consider the amplitude reduction method to be most useful during corrective spinal surgery. The sequences of observations and decisions during a TES-MEP monitoring that is based on this criterion are schematized in a flowchart. (c) 2007 Elsevier Masson SAS. All rights reserved.