Clinical experience with motor and cerebellar evoked potential monitoring.
Clinical experience with motor and cerebellar evoked potential monitoring.
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运动和小脑诱发电位监测的临床经验。
DOI：
10.1097/00006123-198701000-00034
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发表时间：
1987
期刊：
影响因子：
4.8
通讯作者：
W. Levy
中科院分区：
文献类型：
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作者：
W. Levy
本文报告1982 ~ 1986年间进行的98例运动诱发电位（MEP）监测。这些被分为幕上，后颅窝，脊髓类别。我们在该样本中观察到，周围神经或肌电图反应比脊髓对手术中损伤和低血压的反应更敏感，并且通常存在于双侧。周围神经反应的可逆性减弱或丧失与缺陷无关。然而，周围神经反应减弱而没有恢复可能是术后运动缺陷的警告。脊髓反应在损伤条件下的幅度和延迟变化很小，以至于在没有伴随的外周神经和肌肉反应监测的情况下，它们在手术期间的可靠使用可能会受到影响，特别是考虑到手术室中通常困难的记录环境。通过脊髓监测，MEP似乎与我们施加在脊髓上的应力以及随后的临床结果密切相关。在后颅窝病例中，我们观察到MEP对神经系统操作的敏感性和监测病例结局的可靠指示。幕上病例的监测环境更为复杂;一个潜在的陷阱是刺激周围神经和脊髓中产生反应的区域，但不会受到损伤过程的影响。或者，刺激太大面积的皮层或用太高的电流刺激，其穿透到灰质下面的白色物质，可能不会显示损伤。虽然我们没有遇到永久性缺陷的情况下，错过了运动诱发电位，我们关注的外观暂时性缺陷。这些可能与我们的方法的技术局限性，并表明，监测幕上过程需要大量的高可靠性的方法进步。通过先前的体感诱发电位刺激调制MEP似乎是有用的和有前途的。小脑诱发电位反应存在于人类中，并且对损伤敏感。总的来说，这个测试是有希望的。
We are reporting 98 cases of motor evoked potential (MEP) monitoring performed between 1982 and 1986. These were divided into supratentorial, posterior fossa, and spinal cord categories. We observed in this sample that the peripheral nerve or electromyographic response was substantially more sensitive than the spinal cord response to injury and hypotension during operation and was often present bilaterally. Reversible weakening or loss of the peripheral nerve response was not associated with a deficit. However, weakening of the peripheral nerve response without recovery could warn of a motor defect after operation. The spinal cord responses can change so little in amplitude and latency with injury conditions that their reliable use during operation without accompanying peripheral nerve and muscle response monitoring may be compromised, especially in view of the often difficult recording environment in the operating room. With spinal cord monitoring, the MEP seemed closely correlated with the stresses that we imposed on the cord, as well as with subsequent clinical outcome. In posterior fossa cases, we observed sensitivity of the MEP to manipulation of the nervous system and reliable indication of the outcome in the cases monitored. Supratentorial cases present a more complex environment for monitoring; a potential pitfall is to stimulate an area that produces responses in the peripheral nerves and spinal cord, but that is not being compromised by the injury process. Alternatively, stimulating too large an area of cortex or stimulating with too high a current, which penetrates to white matter below the gray matter, may not show an injury. Although we did not encounter cases where permanent deficits were missed by the motor evoked potential, we were concerned by the appearance of temporary deficits. These may be related to technical limitations of our methods and indicate that monitoring of the supratentorial process requires substantial methodological advance for high reliability. Modulation of the MEP by prior somatosensory evoked potential stimulation seems useful and promising. Cerebellar evoked potential responses were present in humans and were sensitive to injury. Overall, this test is promising.