Combined monitoring of evoked potentials during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms.
Combined monitoring of evoked potentials during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms.
复制标题
脑干附近病变和颅内动脉瘤显微手术期间诱发电位的联合监测。
DOI：
10.1097/00029330-200709020-00002
复制
发表时间：
2007
影响因子：
6.1
通讯作者：
Yuan
中科院分区：
文献类型：
--
作者：
D. Kang;Zan;Q. Lan;Liang;Zhang;Chenyang Wang;Yuan
背景
手术期间的神经生理监测是为了防止手术操作导致的永久性神经损伤。为提高术中神经监测的准确性和敏感性，在脑干旁病变和颅内动脉瘤显微手术中，尝试联合应用经颅电刺激运动诱发电位（TES-MEPs）、体感诱发电位（SSEPs）和脑干听觉诱发电位（BAEPs）监测。
方法
在68例脑干附近病变和颅内动脉瘤的连续患者中尝试了TES-MEP与SSEP的联合监测。其中31例（手术31例，后颅窝肿瘤28例，后循环动脉瘤3例）同时进行BAEP监测。前瞻性研究监测结果与临床结局的相关性。
结果
64例（94.1%）行诱发电位联合监测。4例患者（5.9%）无法进行MEP监测。所有患者在联合监测期间均未出现并发症。在68例患者中，45例（66.2%）EP稳定，神经功能完好。运动功能障碍分别由MEP检测8例，SSEP检测5例，BAEP检测4例。
结论
TES-MEP监测结果与术后运动功能密切相关。TES-MEP在检测运动功能障碍方面上级SSEP和BAEP，但联合EP可作为术中监测运动神经系统功能的安全、有效和有创的方法。在脑干和颅内动脉瘤附近病变的显微手术期间监测联合EP可能会发现潜在的危险操作，并提高后续手术的安全性。
BACKGROUND
Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting from surgical manipulation. To improve the accuracy and sensitivity of intraoperative neuromonitoring, combined monitoring of transcranial electrical stimulation motor evoked potentials (TES-MEPs), somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) was attempted in microsurgery for lesions adjacent to the brainstem and intracranial aneurysms.
METHODS
Monitoring of combined TES-MEPs with SSEPs was attempted in 68 consecutive patients with lesions adjacent to the brainstem as well as intracranial aneurysms. Among them, 31 patients (31 operations, 28 of posterior cranial fossa tumors, 3 of posterior circulation aneurysms) were also subjected to monitoring of BAEPs. The correlation of monitoring results and clinical outcome was studied prospectively.
RESULTS
Combined monitoring of evoked potentials (EPs) was done in 64 (94.1%) of the 68 patients. MEPs monitoring was impossible for 4 patients (5.9%). No complication was observed during the combined monitoring in all the patients. In 45 (66.2%) of the 68 patients, EPs were stable, and they were neurologically intact. Motor dysfunction was detected by MEPs in 8 patients, SSEPs in 5, and BAEPs in 4, respectively.
CONCLUSIONS
A close relationship exists between postoperative motor function and the results of TES-MEPs monitoring. TES-MEPs are superior to SSEPs and BAEPs in detecting motor dysfunction, but combined EPs serve as a safe, effective and invasive method for intraoperative monitoring of the function of the motor nervous system. Monitoring of combined EPs during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms may detect potentially hazardous maneuvers and improve the safety of subsequent procedures.