Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves
Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves
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DOI：
10.3171/jns.2006.104.1.85
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发表时间：
2006-01-01
影响因子：
4.1
通讯作者：
Kobayashi, H
中科院分区：
文献类型：
--
作者：
Fujiki, M;Furukawa, Y;Kobayashi, H
物体。本研究的目的是比较从肌肉记录的运动诱发电位(肌肉MEP或皮质肌肉MEP)和从颈硬膜外间隙记录的皮质脊髓MEP(脊髓MEP或皮质脊髓MEP)，以评估其在术中运动功能监测中的有效性。术中对80例脑肿瘤患者同时记录肌肉和脊髓MEP。根据MEP的最终变化分为4组：1)A组，肌肉MEP波幅增加，13波幅增加(12例)；2)B组，MEP波幅110明显改变(43例)；3)C组，肌肉MEP波幅降低(仅为对照组的35%)，I波波幅降低，D波无变化(15例)；A组患者肌肉MEP波幅增加(幅度128-280%，平均增加188.75+/-48.79%)与皮质脊髓MEP的13个波群增加密切相关。这些模式多见于脑膜瘤患者(12例中有10例，占83.3%)。B组患者肌肉和皮质脊髓MEP无变化，无术后神经功能恶化征象。C组患者术后肌肉MEP波幅明显下降(对照波幅下降5.3~34.8%，平均下降21.8±10.93%)，皮质脊髓D波无明显恶化，术后即刻出现严重的运动功能障碍。这表明大脑皮质灰质功能障碍，包括本应产生I波的运动皮质。D组患者皮质脊髓1)波下降(下降幅度21.5~55%，平均下降39.75+/-11.45%)，肌肉MEP即刻停止，并出现严重的永久性运动障碍。这些结果表明，在手术中，监测皮质肌肉MEP(与I波有关)是一种比监测皮质脊髓MEP(D波)更敏感的检测即刻运动皮质损害的方法。
Object. The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function.Methods. Muscle and spinal MEPs were simultaneously recorded during surgery in 80 patients harboring brain tumors. Each case was assigned to one of four groups according to final changes in the MEPs: 1) Group A, in which there was an increased amplitude in the muscle MEP with an increased 13 wave amplitude (12 cases); 2) Group B, ill which there wits 110 significant Change in the MEP (43 cases); 3) Group C, ill which there was a decreased muscle MEP amplitude (< 35% of the control) with it decreased I wave amplitude but all unchanged D wave (15 cases); or 4) Group D, in which there was in absent muscle MEP with a decreased D wave amplitude (10 cases). In patients ill Group A, the increase in the amplitude of the muscle MEP (range of increase 128-280%, mean increase 188.75 +/- 48.79%) was well correlated with the increase in the 13 wave in corticospinal MEPs. Most of these patterns were observed in patients harboring meningiomas (10 [83.3%] of 12 cases). Patients in Group B displayed no changes in muscle and corticospinal MEPs and no sign, of: postoperative neurological deterioration. Patients in Group C showed a Substantial decrease in the amplitude of the muscle MEP (range of decrease 5.3-34.8% based on the control waveform, mean change 21.8 +/- 10.93%) without deterioration in the corticospinal D wave, and exhibited severe immediate postoperative motor dysfunction. This indicates dysfunction of (lie cortical gray matter, including the motor cortices, which are Supposed to generate I waves. Patients in Group D exhibited decreases in the corticospinal 1) wave (range of decrease 21.5-55%, mean decrease 39.75 +/- 11.45%) and an immediate cessation of the muscle MEP its well as severe permanent motor paresis.Conclusions. These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).