Transcranial Electrical Motor Evoked Potential Monitoring for Brain Tumor Resection
Transcranial Electrical Motor Evoked Potential Monitoring for Brain Tumor Resection
复制标题
脑肿瘤切除术中的经颅电机诱发电位监测
DOI：
10.1097/00006123-200105000-00021
复制
发表时间：
2001
期刊：
影响因子：
4.8
通讯作者：
P. Kelly
中科院分区：
文献类型：
--
作者：
Henry H. Zhou;P. Kelly
目的 本研究旨在探讨经颅电动诱发电位 (MEP) 监测对于脑肿瘤手术是否安全、可行且有价值。方法 对 50 名连续接受脑肿瘤切除术的患者进行了研究，使用一氧化二氮/异丙酚麻醉。使用 Sentinel 4 诱发电位系统（Axon Systems, Inc.，Hauppauge，NY）在整个手术过程中连续记录 MEP。通过放置在初级运动皮层上的螺旋电极进行经颅电刺激（5次序列；刺激速率，0.5-2Hz；时间常数为0.5ms的方波脉冲；刺激强度，40-160mA）来引发MEP，并通过插入对侧口轮匝肌、二头肌、拇短展肌和胫骨前肌的针电极进行记录。当 MEP 振幅下降超过 50% 时，重复 MEP 刺激，增加刺激强度，并向外科医生报告 MEP 变化。使用可重复的量表在手术前后检查每位患者的运动功能。使用线性回归分析 MEP 振幅降低与运动状态恶化之间的关系。结果 术前神经系统检查显示 38% 的患者（50 名患者中的 19 名）存在轻度至中度运动缺陷（2/5 至 4/5）。大多数患者 (96%) 表现出可记录的基线 MEP。 8 名患者 (16%)（11 块肌肉）的 MEP 持续下降超过 50%。两名患者（三块肌肉）的 MEP 被完全废除。术后运动状态恶化程度与术中MEP振幅降低程度相关（r = -0.864；P < 0.001）。结论 术中 MEP 持续降低 50% 以上与术后运动缺陷相关。 MEP 振幅降低的程度与术后运动状态恶化相关。经颅MEP电监测对于脑肿瘤手术来说是可行、安全且有价值的。
OBJECTIVE This study was designed to examine whether transcranial electrical motor evoked potential (MEP) monitoring is safe, feasible, and valuable for brain tumor surgery. METHODS Fifty consecutive patients undergoing brain tumor resection were studied, using nitrous oxide/propofol anesthesia. MEPs were continuously recorded throughout surgery, using a Sentinel 4 evoked potential system (Axon Systems, Inc., Hauppauge, NY). The MEPs were elicited by transcranial electrical stimulation (train of 5; stimulation rate, 0.5–2 Hz; square wave pulse with a time constant of 0.5 ms; stimulation intensity, 40–160 mA) through spiral electrodes placed over the primary motor cortex and were recorded by needle electrodes inserted into the contralateral orbicularis oris, biceps, abductor pollicis brevis, and anterior tibialis muscles. When MEP amplitudes decreased by more than 50%, MEP stimulation was repeated, with increased stimulation intensity, and MEP changes were reported to the surgeon. The motor function of each patient was examined before and after surgery, using a reproducible scale. The relationship between MEP amplitude decreases and worsening motor status was analyzed using linear regression. RESULTS Preoperative neurological examinations revealed mild to moderate motor deficits (2/5 to 4/5) for 38% of patients (19 of 50 patients). Most of the patients (96%) exhibited recordable baseline MEPs. Persistent MEP decreases of more than 50% were noted for eight patients (16%) (11 muscles). The MEPs were completely abolished in two patients (three muscles). The degree of postoperative worsening of motor status was correlated with the degree of intraoperative MEP amplitude reduction (r = −0.864;P < 0.001). CONCLUSION Persistent intraoperative MEP reductions of more than 50% were associated with postoperative motor deficits. The degree of MEP amplitude reduction was correlated with postoperative worsening of motor status. Transcranial electrical MEP monitoring is feasible, safe, and valuable for brain tumor surgery.