Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors.
Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors.
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DOI：
10.3171/2014.2.peds1392
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Auguste KI
中科院分区：
文献类型：
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作者：
Cheng JS;Ivan ME;Stapleton CJ;Quinones-Hinojosa A;Gupta N;Auguste KI
术中背柱测图、经颅运动诱发电位（TcMEPs）和体感诱发电位（ssep）已被用于成人髓内脊髓肿瘤（IMSCTs）的辅助切除和预测术后运动缺陷。作者试图确定MEP和SSEP波形的变化是否可以类似地预测儿童术后运动障碍。作者回顾了接受imsct切除术的儿童的图表和术中记录，以及背柱测绘和TcMEP和SSEP监测。运动诱发电位数据辅以使用Kartush微刺激器（Medtronic Inc.）获得的肌电图数据。在术前、术后即刻和随访期间，采用医学研究委员会（MRC）量表对运动强度进行分级。机械牵引、空化超声手术吸引器（CUSA）或两者均可降低ssep。分析了12例患者的数据。颈脊髓3例，胸脊髓7例。2例患者出现颈髓交界处及上脊髓病变。半数患者术中MEP发生改变。在这些病例中，正常的多相信号转变为双相信号，这些变化与运动强度的1-2级损失相关。1例患者MEP信号完全消失，强度恢复至MRC 4/5级。2例宫颈高病变患者术中未见MEP改变，术后未见运动障碍。7例患者进行了背柱定位，均准确确定了中线。7例患者体感诱发电位下降。2例患者术中牵引后SSEP均降低2个，但术后无新的感觉发现。另外2例患者术中出现3次牵拉相关的SSEP下降，术后出现新的感觉缺陷，但均得到解决。另外1例患者术中出现与cusa相关的SSEP下降，术后消退，最后1例患者术后出现3个牵拉相关的感觉缺陷和1个cusa相关的感觉缺陷，均未消退。术中TcMEPs和ssep可以预测IMSCT患儿术后运动障碍的程度。该技术与背柱定位相结合，在切除上颈髓病变时特别有用，这通常被认为是高危人群。此外，脊髓对术中重复的SSEP降低的耐受性似乎较差，连续3次损伤最有可能产生术后感觉缺陷。TcMEPs和SSEP波形的变化可以提示需要防止过度操作，从而增加肿瘤切除的安全性。
Intraoperative dorsal column mapping, transcranial motor evoked potentials (TcMEPs), and somatosensory evoked potentials (SSEPs) have been used in adults to assist with the resection of intramedullary spinal cord tumors (IMSCTs) and to predict postoperative motor deficits. The authors sought to determine whether changes in MEP and SSEP waveforms would similarly predict postoperative motor deficits in children. The authors reviewed charts and intraoperative records for children who had undergone resection for IMSCTs as well as dorsal column mapping and TcMEP and SSEP monitoring. Motor evoked potential data were supplemented with electromyography data obtained using a Kartush microstimulator (Medtronic Inc.). Motor strength was graded using the Medical Research Council (MRC) scale during the preoperative, immediate postoperative, and follow-up periods. Reductions in SSEPs were documented after mechanical traction, in response to maneuvers with the cavitational ultrasonic surgical aspirator (CUSA), or both. Data from 12 patients were analyzed. Three lesions were encountered in the cervical and 7 in the thoracic spinal cord. Two patients had lesions of the cervicomedullary junction and upper spinal cord. Intraoperative MEP changes were noted in half of the patients. In these cases, normal polyphasic signals converted to biphasic signals, and these changes correlated with a loss of 1–2 grades in motor strength. One patient lost MEP signals completely and recovered strength to MRC Grade 4/5. The 2 patients with high cervical lesions showed neither intraoperative MEP changes nor motor deficits postoperatively. Dorsal columns were mapped in 7 patients, and the midline was determined accurately in all 7. Somatosensory evoked potentials were decreased in 7 patients. Two patients each had 2 SSEP decreases in response to traction intraoperatively but had no new sensory findings postoperatively. Another 2 patients had 3 traction-related SSEP decreases intraoperatively, and both had new postoperative sensory deficits that resolved. One additional patient had a CUSA-related SSEP decrease intraoperatively, which resolved postoperatively, and the last patient had 3 traction-related sensory deficits and a CUSA-related sensory deficit postoperatively, none of which resolved. Intraoperative TcMEPs and SSEPs can predict the degree of postoperative motor deficit in pediatric patients undergoing IMSCT resection. This technique, combined with dorsal column mapping, is particularly useful in resecting lesions of the upper cervical cord, which are generally considered to be high risk in this population. Furthermore, the spinal cord appears to be less tolerant of repeated intraoperative SSEP decreases, with 3 successive insults most likely to yield postoperative sensory deficits. Changes in TcMEPs and SSEP waveforms can signal the need to guard against excessive manipulation thereby increasing the safety of tumor resection.