The mapping and continuous monitoring of the intrinsic motor nuclei during brain stem surgery.
The mapping and continuous monitoring of the intrinsic motor nuclei during brain stem surgery.
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脑干手术期间内在运动核的测绘和连续监测。
DOI：
10.1227/00006123-199508000-00010
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发表时间：
1995
期刊：
影响因子：
4.8
通讯作者：
Karl Kothbauer
中科院分区：
文献类型：
--
作者：
Wilhelm Eisner;Urs Schmid;Hanns;Reinhard Oeckler;Vladimir Olteanu;Claudius Gall;Karl Kothbauer
开发了一种综合技术，用于在手术过程中对内在脑干运动功能进行连续电生理监测，以去除第四脑室和脑干中的占位性病变。该技术类似于桥小脑角手术中使用的技术。脑神经 III-XII 的运动核和周围脑桥纤维束通过手术区域结构的电刺激和从头部相应肌肉记录的复合肌肉动作电位的评估来识别。通过记录这些相同肌肉中持续的肌电活动来连续监测神经功能。通过扬声器广播肌电图反应，为外科医生提供有关正在监测的运动核状态的即时反馈。该技术的优点包括1）积极、客观地识别细胞核和纤维束； 2）对这些结构状态的持续反馈； 3）通过第四脑室到达脑干病变的安全途径； 4）明确肿瘤与菱形窝运动结构之间的边界； 5) 对外科医生发出手术期间可能有害的神经操作（接触、解剖、横断）的警告。在连续 16 次手术中使用该技术去除海绵状瘤（n = 9）、神经胶质瘤（n = 4）和其他类型的肿瘤（n = 3）后，手术和神经学结果表明该方法可靠且易于操作。
A comprehensive technique was developed for continuous electrophysiological monitoring of intrinsic brain stem motor function during surgery to remove space-occupying lesions in the fourth ventricle and brain stem. The technique is analogous to that used during surgery in the cerebellopontine angle; motor nuclei and peripheral pontine fiber tracts of Cranial Nerves III-XII are identified by the electrical stimulation of structures in the operative field and the evaluation of the compound muscle action potentials recorded from the corresponding muscles of the head. Nerve function is monitored continuously by recording the ongoing electromyographic activity in these same muscles. Broadcasting electromyographic responses through a loudspeaker gives the surgeon immediate feedback on the status of the motor nuclei being monitored. Advantages of this technique include 1) the positive, objective identification of the nuclei and fiber tracts; 2) the continuous feedback on the status of these structures; 3) a safe approach through the fourth ventricle to the lesions in the brain stem; 4) the positive identification of the boundaries between the neoplasm and the motor structures of the rhomboid fossa; and 5) a warning to the surgeon of potentially harmful nerve manipulations (contact, dissection, transection) during surgery. After this technique was used in 16 consecutive operations to remove cavernomas (n = 9), gliomas (n = 4), and other types of tumors (n = 3), surgical and neurological results showed the method to be reliable and simple to perform.