低场强术中磁共振环境下的神经电生理监测

目的 探讨低场强iMRI环境下神经电生理监测(IOM)的操作特点与临床初步体会.方法 分析9例功能区脑肿瘤10M及iMRI的联合应用情况.采集IOM基线,与iMRI环境下的波形比较;记录iMRI影像畸变及电刺激相关不良事件.术后早期复查MRI评估肿瘤切除隋况.结果 9例行IOM均获得稳定波形.1例前置放大器冈磁电效应损坏,未观察到热损伤或电极移动损伤.iMRI 7例局部信号缺失;3例发现肿瘤残余.术后随访MRI 7例全切,2例次全切除,与iMRI判断一致.结论 低场强iMRI环境下,IOM可获得稳定波形.二者联合应用,有助于病变安全切除.

Intraoperative neurophysiological monitoring in low-field MRI environment

Objective To evaluate methodological aspects and preliminary clinical experience in 9 patients for intraoperative neurophysiological monitoring(IOM)in low-field intraoperative MRI(iMRI) system.Methods Data of 9 patients with intracerebral neoplasms in eloquent areas underwent tumor resection assisted by both iMRI and IOM were reviewed.Before the maglmt was brought out from the cabinet.we got the "baseline"IOM waveform in order to compare with the wavoform within iMRI environment. Meanwhile.adverse effects caused by electrical stimulation and image distortions of iMRl were recorded.Early high-field MRI was performed to evalante the tumor resection after the operation.Results Combined use of iMRI and direct electrical stimulation (DES) Was performed in all patients.IOM could be performed with good quality within a low-field iMRI environment.However.a preamplifier was damaged during the monitoring in 1 case for magnetoelectric effect.The damage caused by heat or electrode movement was not observed.For image quality,signal voids were observed in the image areas which were very close to the scalp electrodes in 7 patients.Further tumor resection was performed in 3 patients for residual tumor demonstrated by iMRI.The completion of presurgical planning was achieved in all cases(7 total resection.2 subtotal resection).The iMRI findings were consistent with postoperative hish-field imaging in all cases.Conclusions IOM can be performed with standard quality within a low-field iMRI environment.The combined use of low-field open iMRI and IOM allows tumor resection control and continuous functional monitoring.