Intraoperative Motor Evoked Potential Alteration in Intracranial Tumor Surgery and Its Relation to Signal Alteration in Postoperative Magnetic Resonance Imaging
Intraoperative Motor Evoked Potential Alteration in Intracranial Tumor Surgery and Its Relation to Signal Alteration in Postoperative Magnetic Resonance Imaging
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DOI：
10.1227/01.neu.0000371973.46234.46
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发表时间：
2010-08-01
期刊：
影响因子：
4.8
通讯作者：
Ziemann, Ulf
中科院分区：
文献类型：
--
作者：
Szelenyi, Andrea;Hattingen, Elke;Ziemann, Ulf
目的：确定颅内手术中孤立的、单侧运动诱发电位 (MEP) 改变的模式与运动结果和磁共振成像 (MRI) 上新的术后信号改变的位置相关的程度。 方法：在 29 名患者（年龄，42.8 +/- 18.2 岁；15 名女性患者；25 名幕上手术，4 名幕下手术）中，术中 MEP 单独改变（其他诱发电位模式没有显着改变）分别被分类为恶化（> 50% 振幅下降和/或运动阈值增加）或丧失，或可逆和不可逆。术后 MRI 描述了新信号改变的位置和类型。 结果：所有 5 名不可逆 MEP 丧失的患者均出现新的运动缺陷，10 名不可逆 MEP 恶化的患者中有 7 名出现新的运动缺陷，6 名可逆 MEP 丧失的患者中有 1 名出现新的运动缺陷，8 名可逆 MEP 恶化的患者中有 0 名出现新的运动缺陷。与可逆性 MEP 改变相比，不可逆性改变与术后运动缺陷的相关性明显更高 (P < .0001)。在 20 名患者中，22 个新信号改变影响了 29 个不同位置（中央前回，n = 5；皮质脊髓束，n = 19）。与可逆 MEP 改变相比，不可逆 MEP 改变更常与 MRI 术后新信号改变相关 (P = .02)。 MEP 损失通常与位于皮质下的新信号改变相关 (P = .006)。 MEP 恶化后明显更常见的是位于中央前回的新信号改变 (P = .04)。结论：由于皮质脊髓束中皮层下术后 MR 变化导致术后运动缺陷，MEP 丧失比 MEP 恶化的风险更高。相反，MEP 恶化表明运动皮层病变。因此，如果在运动皮层附近进行手术，即使 MEP 恶化也应被视为警告信号。
OBJECTIVE: To determine the degree to which the pattern of intraoperative isolated, unilateral alteration of motor evoked potential (MEP) in intracranial surgery was related to motor outcome and location of new postoperative signal alterations on magnetic resonance imaging (MRI).METHODS: In 29 patients (age, 42.8 +/- 18.2 years; 15 female patients; 25 supratentorial, 4 infratentorial procedures), intraoperative MEP alterations in isolation (without significant alteration in other evoked potential modalities) were classified as deterioration (> 50% amplitude decrease and/or motor threshold increase) or loss, respectively, or reversible and irreversible. Postoperative MRI was described for the location and type of new signal alteration.RESULTS: New motor deficit was present in all 5 patients with irreversible MEP loss, in 7 of 10 patients with irreversible MEP deterioration, in 1 of 6 patients with reversible MEP loss, and in 0 of 8 patients with reversible MEP deterioration. Irreversible compared with reversible MEP alteration was significantly more often correlated with postoperative motor deficit (P < .0001). In 20 patients, 22 new signal alterations affected 29 various locations (precentral gyrus, n = 5; corticospinal tract, n = 19). Irreversible MEP alteration was more often associated with postoperative new signal alteration in MRI compared with reversible MEP alteration (P = .02). MEP loss was significantly more often associated with subcortically located new signal alteration (P = .006). MEP deterioration was significantly more often followed by new signal alterations located in the precentral gyrus (P = .04).CONCLUSION: MEP loss bears a higher risk than MEP deterioration for postoperative motor deficit resulting from subcortical postoperative MR changes in the corticospinal tract. In contrast, MEP deterioration points to motor cortex lesion. Thus, even MEP deterioration should be considered a warning sign if surgery close to the motor cortex is performed.