Intra-operative monitoring of lower extremity motor-evoked potentials by direct cortical stimulation
Intra-operative monitoring of lower extremity motor-evoked potentials by direct cortical stimulation
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DOI：
10.1016/j.clinph.2011.09.025
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发表时间：
2012-06-01
影响因子：
4.7
通讯作者：
Suzuki, Michiyasu
中科院分区：
文献类型：
--
作者：
Maruta, Yuichi;Fujii, Masami;Suzuki, Michiyasu
目的：运动诱发电位（MEP）通常从上肢肌肉记录，而下肢MEP（LE-MEP）监测尚未充分建立。本研究的目的是开发一种MEP监测方法，使用直接皮层刺激（DCS）预测运动功能障碍的下肢。方法：术中LE-MEP监测22例患者。开颅手术后，将硬膜下电极放置在皮质上，使最佳接触位置位于运动皮质中线外侧2 cm处。用于刺激的电极由Fpz处的阴极和运动皮层上的最佳接触部位处的阳极组成。结果：所有患者下肢肌肉均能记录到LE-MEP。在5例患者中观察到MEP波形消失或幅度降低，但MEP波形已恢复并通过硬脑膜闭合保持在对照水平，并且在任何患者中均未观察到永久性运动缺陷。结论：我们在幕上手术期间使用单极DCS并将硬膜下电极放置在运动皮层的凸侧来完成LE-MEP记录。本文介绍了一种术中记录LE-MEP的有效方法。(C)2011年国际临床神经生理学联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: Motor-evoked potentials (MEPs) are commonly recorded from upper-extremity muscles, whereas lower-extremity MEP (LE-MEP) monitoring has not been adequately established. The goal of the study was to develop a MEP monitoring method using direct cortical stimulation (DCS) for predicting motor deficits of lower extremities.Methods: Intra-operative LE-MEP monitoring was performed in 22 patients. After craniotomy, a subdural electrode was placed on the cortex so that the optimal contact was positioned 2 cm lateral from the midline on the motor cortex. The electrodes for stimulation consisted of a cathode at Fpz and an anode at the optimal contact site on the motor cortex. After stimulation was performed with short trains of five stimuli, LE-MEPs were recorded from the lower-limb muscles.Results: LE-MEPs were consistently recorded in all patients. Disappearance or amplitude reduction of MEP waveforms was observed in five patients, but the MEP waveforms had recovered and remained at the control level by dural closure, and no permanent motor deficit was observed in any patient.Conclusions: We accomplished LE-MEP recording during supratentorial surgery using monopolar DCS with a subdural electrode placed on the convex side of the motor cortex.Significance: A useful method of intra-operative LE-MEP recording was described. (C) 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.