Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials.
Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials.
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DOI：
10.1016/j.xjtc.2020.08.006
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发表时间：
2020-12
期刊：
影响因子：
1.6
通讯作者：
Shiiya N
中科院分区：
文献类型：
--
作者：
Yamanaka K;Tsuda K;Takahashi D;Washiyama N;Yamashita K;Shiiya N
虽然在犬的实验中，单极颈髓刺激诱发的经食道运动诱发电位比经颅运动诱发电位更稳定和快速，但直接刺激颈髓α运动神经元阻碍了临床应用。我们评估了一种新的刺激方法，使用双极食道电极来实现胸髓刺激。20只狗被麻醉。对于双极经食道刺激，电极间距离设置为4 cm。测量对递增刺激强度(100-600 V)的反应幅度的变化，以评价稳定性。T8~T10节段主动脉球囊阻断10分钟以评估反应时间，或T3~T5节段阻断25分钟以评估预后价值。术后24、48小时用Tarlov评分评定神经功能。所有动物的双极经食道刺激均成功，其前肢波形与经颅刺激后相同。单极和双极经食道刺激产生的最大波幅的90%的最小刺激强度均显著低于经颅刺激(n=0.5)。单极和双极经食道刺激的后肢电位消失和恢复时间(>；75%)均明显短于经颅刺激(n=0.5)。在所有刺激方法中，与神经学结果的相关性具有可比性(n=10)。双极经食道胸段脊髓刺激可在不直接刺激颈α运动神经元的情况下诱发运动诱发电位，其稳定性和反应时间与单极刺激相当。
Although transesophageal motor-evoked potential elicited by monopolar cervical cord stimulation is more stable and rapid in response to ischemia than transcranial motor-evoked potential in canine experiments, direct cervical alpha motor neuron stimulation precludes clinical application. We evaluated a novel stimulation method using a bipolar esophageal electrode to enable thoracic cord stimulation. Twenty dogs were anesthetized. For bipolar transesophageal stimulation, the interelectric pole distance was set at 4 cm. Changes in amplitude in response to incremental stimulation intensity (100-600 V) were measured to evaluate stability. Spinal cord ischemia was induced by aortic balloon occlusion at the T8 to T10 level for 10 minutes to evaluate response time or at the T3 to T5 level for 25 minutes to evaluate prognostic value. Neurological function was evaluated using the Tarlov score at 24 and 48 hours postoperatively. Bipolar transesophageal stimulation was successful in all animals and their forelimb waveforms were identical to those after transcranial stimulation. The minimum stimulation intensity to produce >90% of the maximum amplitude was significantly lower in both monopolar and bipolar transesophageal stimulation than in transcranial stimulation (n = 5). Time to disappearance and recovery (>75%) of the hindlimb potentials were significantly shorter by both monopolar and bipolar transesophageal stimulation than by transcranial stimulation (n = 5). Correlation with neurological outcomes was comparable among all stimulation methods (n = 10). Motor-evoked potential can be elicited by bipolar transesophageal thoracic cord stimulation without direct cervical alpha motor neuron stimulation, and its stability and response time are comparable to those elicited by monopolar stimulation.
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