INTRAOPERATIVE NERVE ACTION POTENTIAL RECORDINGS: TECHNICAL CONSIDERATIONS, PROBLEMS, AND PITFALLS
INTRAOPERATIVE NERVE ACTION POTENTIAL RECORDINGS: TECHNICAL CONSIDERATIONS, PROBLEMS, AND PITFALLS
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DOI：
10.1227/01.neu.0000347473.67188.75
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发表时间：
2009-10-01
期刊：
影响因子：
4.8
通讯作者：
Kline, David G.
中科院分区：
文献类型：
--
作者：
Robert, Everett G.;Happel, Leo T.;Kline, David G.
目的：本文旨在提供术中神经动作电位（NAP）记录的经验。特别地，我们集中讨论术中NAP的技术考虑，重点是识别和纠正问题和陷阱。方法：我们报告了可能是最大的手术系列的周围神经病变，术中NAP记录来自1736例患者，其中3459例病变与手术结果一致。我们特别关注那些我们认为NAP记录困难或具有误导性的患者。结果：在路易斯安那州立大学健康科学中心评分系统中，94.7%的神经元件的NAP阳性导致神经松解，其功能为3级或更高。差异神经束记录导致62个神经分裂修复，58个神经恢复。NAP的缺失在组织学上与神经性病变相关。1975例神经修复后，1111例恢复到3级或以上。结论：连续性神经病变的目视检查容易引起误解。虽然我们的数据与不使用术中NAP记录的数据没有“正面”的比较，但我们强烈地感觉到，有了关于术中记录技术的问题和陷阱的经验和知识，我们可以利用这种非常有用和信息丰富的手术工具的巨大好处。
OBJECTIVE: The purpose of this article is to provide our experience with intraoperative nerve action potential (NAP) recordings. In particular, we focus on a discussion of the technical considerations of intraoperative NAP with emphasis on identifying and remedying problems and pitfalls.METHODS: We report, perhaps, the largest operative series of peripheral nerve lesions in continuity with intraoperative NAP recording derived from 1736 patients with 3459 lesions in continuity with operative outcomes. We pay special attention to patients for whom we felt that NAP recordings were either difficult or misleading.RESULTS: A positive NAP across a lesion resulting in neurolysis gave grade 3 or better function using the Louisiana State University Health Science Center grading system in 94.7% of neural elements. Differential fascicular recordings resulted in split repair in 62 nerves with recovery in 58. The absence of an NAP correlated histologically with a neurotmetic lesion. With resultant repair, 1111 of 1975 nerves recovered to grade 3 or better.CONCLUSION: Visual inspection of a nerve lesion in continuity call be misleading. Although there is no "head-to-head" comparison of our data with data obtained without the use of intraoperative NAP recordings, we feel strongly that with experience and knowledge of the problems and pitfalls regarding intraoperative recording techniques, I one may take advantage of the great benefits of this very useful and informative surgical tool.