Changes in Transcranial Motor Evoked Potentials during Intramedullary Spinal Cord Tumor Resection Correlate with Postoperative Motor Function
Changes in Transcranial Motor Evoked Potentials during Intramedullary Spinal Cord Tumor Resection Correlate with Postoperative Motor Function
复制标题
髓内脊髓肿瘤切除过程中经颅运动诱发电位的变化与术后运动功能相关
DOI：
10.1227/01.neu.0000158203.29369.37
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发表时间：
2005
期刊：
影响因子：
4.8
通讯作者：
P. Weinstein
中科院分区：
文献类型：
--
作者：
A. Quiñones‐Hinojosa;Russ Lyon;G. Zada;K. Lamborn;N. Gupta;A. Parsa;M. McDermott;P. Weinstein
目的：经颅运动诱发电位(TcMEPs)术中监测是预防脊髓髓内肿瘤(IMSCT)术后运动功能障碍的重要手段。在这项研究中，我们假设肿瘤切除术中MEP的变化与术后运动功能障碍有关。方法：对28例在44个月期间接受肌源性或肌肉记录的TcMEP切除IMSCT的患者进行了回顾性记录回顾。分析术中MEP记录和术前、术后即刻及后续神经学检查的结果。结果：在使用TcMEPs切除IMSCT的28名患者中，有13名患者(46%)出现了MEP改变。运动传导受损表现为MEP波形形态的改变(9例多相至双相，5例多相至双相，1例两者均有改变)和电压阈值升高(中位数为175V；范围为100~225V；n=22条肢体)。尽管刺激电压显著增加，MEP反应的形态改变和持续时间的缩短仍持续存在。在12名患者中，TcMEP波形复杂性和/或丢失的减少与术后即刻(P<；0.0001)、出院时(P<；0.001)和随访时(P<；0.001)的运动分级损失相关。反应持续时间的缩短与术后即刻(P<；0.001)、出院时(P<；0.0001)和随访时(P<；0.005)的运动评分损失有关。结论：这些结果支持应用远端肌肉记录的TcMEPs来预测IMSCT切除术中运动障碍的发生和严重程度。注意这些量化的术中监测数据可能有助于在肿瘤切除术中避免或纠正过度的脊髓操作和改进手术技术，从而最大限度地减少术后运动障碍。
OBJECTIVE:Intraoperative monitoring of transcranial motor evoked potentials (TcMEPs) has been investigated recently as a means of preventing motor deficits associated with resection of intramedullary spinal cord tumors (IMSCTs). In this study, we hypothesized that changes in the intraoperative MEPs during tumor resection correlate with postoperative motor function deficits. METHODS:A retrospective record review was conducted for 28 patients who underwent resection of an IMSCT using myogenic or muscle-recorded TcMEPs during a 44-month period. Intraoperative MEP recordings and results from preoperative, immediate postoperative, and subsequent follow-up neurological examinations were analyzed. RESULTS:Of the 28 patients who underwent resection of an IMSCT using TcMEPs, MEP changes occurred in 13 patients (46%). Impaired motor conduction was detected by changes in pattern and duration of the MEP waveform morphology (polyphasic to biphasic in 9 patients and polyphasic to biphasic to loss of MEP response in 5 patients, 1 patient demonstrated both changes) and by an increase in voltage threshold (median, 175 V; range, 100–225 V; n = 22 extremities). Alterations in morphology and reduction in duration of the MEP response persisted despite significant increases in stimulation voltage. In 12 patients, reductions in the complexity and/or loss of the TcMEP waveform correlated with motor grade loss in the immediate postoperative period (P < 0.0001), at discharge (P < 0.001), and at follow-up (P < 0.001). The decrease in the duration of the response correlated with motor grade loss immediately after surgery (P < 0.001), at discharge (P < 0.0001), and at follow-up (P < 0.005). CONCLUSION:These results support the application of distal muscle-recorded TcMEPs to predict the occurrence and severity of postoperative motor deficits during resection of IMSCTs. Attention to such quantitative intraoperative monitoring data may help to minimize postoperative motor deficits by avoiding or correcting excessive spinal cord manipulation and modifying surgical technique during tumor resection.