Localisation of the sensorimotor cortex during surgery for brain tumours:: feasibility and waveform patterns of somatosensory evoked potentials
Localisation of the sensorimotor cortex during surgery for brain tumours:: feasibility and waveform patterns of somatosensory evoked potentials
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DOI：
10.1136/jnnp.72.2.221
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发表时间：
2002-02-01
影响因子：
11
通讯作者：
Strauss, C
中科院分区：
文献类型：
--
作者：
Romstöck, J;Fahlbusch, R;Strauss, C
目的：术中使用体感诱发电位（sep）的相位反转定位感觉运动皮层是在周围脑回内和周围手术的重要工具，但报道了不成功和令人困惑的结果。本研究探讨肿瘤肿块对SEP波形特征的影响，并将其与功能性神经导航和脑皮层电成像进行比较。方法：在230例感觉运动区肿瘤患者中，采用硬膜下栅格或条形电极记录外露皮层N20-P20的SEP相反转。其中一个亚组的80名患者通过运动和感觉磁源成像进行功能性神经导航，另一个亚组的40名患者通过电刺激作图定位手部运动皮层区域。结果：术中SEP法的成功率为92%，成功率与病变部位的关系大于与术前神经功能缺损的关系。在13%的中枢后肿瘤患者中，没有记录到N20-P20期逆转，但在25 ms时，特征性的多相和高振幅波使中枢后回的识别成为可能。运动皮层的电图绘制花了30分钟，直到得到一个清晰的结果。37例患者成功，但3例中心前和中心病变患者失败。功能神经导航显示肿瘤边缘和运动和感觉诱发场在所有患者中都是可能的。结论：N20-P20的SEP期逆转是一种简单可靠的技术，但在大型中央和中央后肿瘤中成功率较低。使用多相晚期波形可以定位感觉运动皮层。与电机电映射相比，它消耗的时间更少。功能性神经导航是术前手术计划和术中用于周围肿瘤手术的理想工具，但补偿脑转移，准确性和成本效益仍然是一个值得讨论的问题。
Objective: Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping.Methods: In 230 patients with tumours of the sensorimotor region the SEP phase reversal of N20-P20 was recorded from the exposed cortex using a subdural grid or strip electrode. In one subgroup of 80 patients functional neuronavigation was performed with motor and sensory magnetic source imaging and in one subgroup of 40 patients the motor cortex hand area was localised by electrical stimulation mapping.Results: The intraoperative SEP method was successful in 92% of all patients, it could be shown that the success rate rather depended on the location of the lesion than on preoperative neurological deficits. In 13% of the patients with postcentral tumours no N20-P20 phase reversal was recorded but characteristic polyphasic and high amplitude waves at 25 ms and later made the identification of the postcentral gyrus possible nevertheless. Electrical mapping of the motor cortex took up to 30 minutes until a clear result was obtained. It was successful in 37 patients, but failed in three patients with precentral and central lesions. Functional neuronavigation indicating the tumour margins and the motor and sensory evoked fields was possible in all patients.Conclusion: The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.