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| 脑动脉瘤锁孔手术中经颅骨内电极阈值刺激模式下运动诱发电位监测的应用 |
| 吴赞艺1,洪岳禅1,王丰1,黄小芬1,余良宏1,林元相1,康德智1,黄景峰2,林章雅1* |
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(1. 福建医科大学附属第一医院神经外科, 福州 350005;
2. 福建医科大学附属第一医院麻醉科, 福州 350005
*通信作者) |
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| 摘要: |
| 目的 探讨在脑动脉瘤锁孔手术中采用经颅骨内电极（cranial peg-screw electrode，CPSE）阈值刺激模式下激发运动诱发电位（motor evoked potential，MEP）对监测术后运动功能损伤的优势。方法 选取大脑前循环动脉瘤患者31例，行锁孔入路显微夹闭手术。手术侧采用CPSE在阈值刺激下监测MEP，非手术侧在相同刺激阈值下采用经颅电刺激（transcranial electric stimulation，TES）监测MEP，观察术中监测所需的最小刺激电压变化，并将术中MEP监测结果与术后运动功能进行前瞻性观察研究。结果 手术侧28例患者在阈值刺激下成功诱发MEP，3例未引出。所有病例均未出现与MEP监测相关的并发症。术中MEP变化达到警报标准者3例，其中2例术后出现暂时性偏瘫；未达到警报标准25例，术后均未出现新的运动功能障碍，敏感性为100%（2/2），特异性为96.30%（26/27）。结论 脑动脉瘤手术中采用CPSE阈值刺激模式进行MEP监测是可行的、安全可靠的，对脑缺血所致运动功能损伤具有良好的敏感性和特异性，可作为常规MEP监测的一种替代方法。 |
| 关键词: 颅内动脉瘤 运动诱发电位 电极 手术中监测 |
| DOI：10.16781/j.0258-879x.2016.10.1277 |
| 投稿时间：2016-01-31修订日期：2016-04-01 |
| 基金项目:福建省卫生厅青年科研基金（2011-1-17），福建省科技重大专项（2014YZ0003/2014YZ0003-1），福建省临床重点专科项目. |
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| Application of motor evoked potential monitoring under threshold-level electrical stimulation using cranial peg-screw electrode during cerebral aneurysm keyhole approach surgery |
| WU Zan-yi1,HONG Yue-chan1,WANG Feng1,HUANG Xiao-fen1,YU Liang-hong1,LIN Yuan-xiang1,KANG De-zhi1,HUANG Jing-feng2,LIN Zhang-ya1* |
(1. Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China;
2. Department of Anesthesia, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China
*Corresponding author) |
| Abstract: |
| Objective To explore the advantage of motor evoked potentials (MEPs) monitoring for postoperative motor deficit evaluation under threshold-level electrical stimulation using cranial peg-screw electrode (CPSE) during cerebral aneurysm keyhole approach microsurgery. Methods A total of 31 patients who underwent anterior circulation aneurysm microsurgery through keyhole approach were selected in this study. MEPs monitoring of the operation side was conducted with threshold-level electrical stimulation using CPSE, and that of the non-operation side was conducted with transcranial electric stimulation using the same stimulation threshold. The change of minimum voltage required for MEPs monitoring was observed and recorded. The intraoperative MEPs monitoring results and postoperative neurological functions were analyzed by prospective observational study. Results MEPs of the operation side was successfully induced in 28 cases. No complications related to MEPs monitoring were observed. Intraoperative MEPs abnormalities were monitored in 3 cases, and 2 of them had postoperative transient hemiplegia, showing a sensitivity of 100% (2/2). No motor dysfunction was observed in the other 26 cases who were not presented with intraoperative MEPs abnormalities in 25 cases, showing a specificity of 96.30%(26/27). Conclusion MEPs monitoring with threshold-level electrical stimulation using CPSE is a feasible and reliable method and it has satisfactory sensitivity and specificity for predicting motor dysfunction induced by cerebral ischemia, indicating that this method can be an alternative for routine MEPs monitoring with conventional transcranial electrical stimulation in cerebral aneurysm microsurgery. |
| Key words: intracranial aneurysm motor evoked potentials electrode intraoperative monitoring |
