术中肌电监测对累及第四脑室底面肿瘤切除中后组脑神经核团的保护研究

目的 探讨术中肌电监测在累及第四脑室底面肿瘤切除术中,后组脑神经核团的保护作用.方法 2007年2月至2008年4月治疗23例累及第四脑室底面的肿瘤,其中巨大髓母细胞瘤8例,室管膜瘤7例,脑干起源外生性胶质瘤3例,脑干背侧血管网状细胞瘤2例,脑干海绵状血管瘤3例.全部患者通过显微手术切除肿瘤,术中全程监测后组脑神经肌电活动.对患者术后脑神经功能状态、手术过程和监测情况分析.结果 肿瘤全切除17例,次全切除6例,无后组脑神经功能障碍6例,轻度后组腩神经损伤13例,中度后组腩神经损伤4例,无严重损伤者.术中全部患者在正常麻醉和肌松药状态下,可以稳定引出各种刺激诱发的后组脑神经核团兴奋性肌电活动.结论 术中肌电监测可以有效避免后组脑神经核性损伤,为第四脑室底面肿瘤切除提供客观依据.     

神经电生理监测在儿童第四脑室肿瘤显微手术中的临床应用

目的 神经电生理监测在探讨儿童第四脑室肿瘤显微手术中的应用价值。方法 回顾性分析2007年1月至 2012年12月46例神经电生理监测下显微手术（监测组）及45例常规显微手术（对照组）治疗的儿童第四脑室肿瘤患者的临床资料。结果 手术全切除75例（监测组38例,对照组37例）;监测组和对照组出现新颅神经损伤症状发生率分别为0和11.1%、原有颅神经损伤症状加重比率分别为2.2%和13.3%, 差异有统计学意义（P<0.05）;永久性神经损伤发生率分别为0和 6.7%,差异无统计学意义（P>0.05）。结论 第四脑室肿瘤患儿显微手术中进行神经电生理监测可以最大可能切除肿瘤,减少术中脑干损伤。     

神经电生理监测异常肌反应在面肌痉挛术中的作用

目的 评价异常肌反应（AMR）监测在面肌痉挛微血管减压术（MVD）中的应用价值。方法 2011年4月至2013年7月收治的88例面肌痉挛患者,均行MVD治疗,采用神经电生理监测AMR波指导手术。结果 术前所有患者均监测到AMR波,压迫面神经的血管减压后76例（86.4%）AMR波消失,12例（13.7%）AMR波未消失。术后随访结果6个月,AMR波消失的76例患者中,75例面肌痉挛消失,1例痉挛程度较术前明显缓解;AMR波未消失的12例患者,8例面肌痉挛消失,3例较术前明显缓解,1例无效。结论 面肌痉挛患者MVD术中监测AMR波有助于鉴别责任血管、评价手术减压效果、判断手术后患者的预后。     

桥小脑角区肿瘤术中面神经功能监护

目的总结桥小脑角区肿瘤术中面神经功能的电生理监测经验。方法对48例桥小脑角区肿瘤病人术中应用肌电图进行连续实时监护，同时进行脑于听觉诱发电位监测，结果术中当接近、触及、牵拉、刺激面神经时，自发肌电图出现突发、双相或多相的高幅电位改变，面神经得以准确定位。脑干听觉诱发电位各波变化中以Ⅴ波潜伏期延长及波幅降低最为显著。肿瘤全切除45例．面神经解剖保留44例，功能保留38例，术后2周House—Brackmann面神经功能分级：Ⅰ-Ⅱ级38例，Ⅲ～Ⅳ级8例，Ⅴ级2例；其中Ⅰ～Ⅱ级的术中刺激值为0．1～0．2mA。尢死亡及长期昏迷病例。结论突发的双相或多相的高幅肌电图改变，及脑干听觉诱发电位示Ⅴ波潜伏期延长和波幅下降，均为敏感的变化指标：桥小脑角区肿瘤术中实施监护．有助于提高面神经的功能保留率。     

肌电、诱发电位术中监测原理及临床应用

近年来肌电、诱发电位监测在外科手术中得到越来越多的应用．已成为桥小脑角肿瘤切除术、脊髓手术、三叉神经血管减压术及其他可能对神经产生影响的手术的常规监测方法。应用肌电和诱发电位相结合,自发肌电和诱发肌电相结合,选择适当的神经通路和导联组合进行监测,为外科医师术中提供涉及的神经功能状态．并在切除肿瘤后对神经受损情况进行评价和预后判断。     

颅神经运动核的定位及持续肌电图监测在脑干手术中的应用

脑干手术，尤其是脑干实质内病变的手术很容易导致脑干重要功能核团颅神经运动核(cranial motor nuclei，CMN)的损害而导致严重的术后并发症。运用神经电生理技术在脑干手术中对CMN进行术中定位和持续肌电图(continuous electromyographic，cEMG)监测，将有可能最大限度地切除病变的同时，帮助术者确定并保留CMN的功能，降低手术并发症。     

肌电图监测在听神经瘤手术中的应用

目的探讨肌电图监测在听神经瘤手术中的应用。方法收集2016年1月至2017年12月收治的听神经瘤患者术中记录的口轮匝肌和眼轮匝肌的针状电极肌电图(electromyography,EMG)资料,分析术中A trains等自发肌电反应(spontaneous muscle activity,SMA)对术后面神经功能状态的预测作用。结果 61例患者进行了面神经SMA监测,面神经均得到解剖保留。其中53例监测到SMA,33例患者的SMA中出现了A trains,20例患者出现其他形式的SMA。两组患者术后1周面神经功能损伤分别为21例和7例,短期面神经功能损伤差异有统计学意义(P=0. 043 0. 05),术后1年面神经功能损伤患者分别为16例和5例,长期面神经功能损伤差异没有统计学意义(P=0. 090 0. 05)。结论术中SMA能够帮助术者定位面神经及减少其医源性损伤; A trains较其他SMA类型在评估术后短期(1周)面神经功能损伤方面具有意义,评估术后长期(1年)面神经功能损伤无意义。     

术中神经电生理监测在椎管肿瘤手术中的应用

脊髓肿瘤患者在手术过程中常常会因手术机械性损伤直接导致的脊髓损害和脊髓缺血间接导致的脊髓损害而加重原有的脊髓、神经损伤或造成新的医源性损伤,严重者可导致感觉、运动和大小便功能永久性障碍。因此,在脊髓手术中避免对脊髓造成损伤至关重要。近年来,随着神经电生理监测技术的发展,在全麻脊髓肿瘤手术中开展神经电生理监测以保护脊髓传导通路的完整性,术后躯体感觉、运动功能,尿道及肛门括约肌功能的正常已取得了很好的效果。     

肌电图监测在听神经瘤手术中的应用

目的 探讨肌电图监测在听神经瘤手术中的应用。方法 收集2016年1月至2017年12月收治的听神经瘤患者术中记录的口轮匝肌和眼轮匝肌的针状电极肌电图（electromyography,EMG）资料,分析术中A trains等自发肌电反应（spontaneous muscle activity,SMA）对术后面神经功能状态的预测作用。结果 61例患者进行了面神经SMA监测,面神经均得到解剖保留。其中53例监测到SMA,33例患者的SMA中出现了A trains,20例患者出现其他形式的SMA。两组患者术后1周面神经功能损伤分别为21例和7例,短期面神经功能损伤差异有统计学意义（P=0.043<0.05）,术后1年面神经功能损伤患者分别为16例和5例,长期面神经功能损伤差异没有统计学意义（P=0.090>0.05）。结论 术中SMA能够帮助术者定位面神经及减少其医源性损伤;A trains较其他SMA类型在评估术后短期（1周）面神经功能损伤方面具有意义,评估术后长期（1年）面神经功能损伤无意义。     

脑电监测在癫痫手术中的应用

癫痫是一种常见疾病 ,脑电检查在致痫灶的术前定位及手术中监测起着重要的作用 ,回顾我科1996年 1月～ 1999年 11月实施的癫痫手术 4 9例 ,对脑电监测在其中的应用加以总结分析。临床资料1 一般资料 :本组男性 32例 ,女性 17例 ,年龄7～ 4 2岁 ,平均 19 4岁。病程 5～ 2 2年 ,平均 8 3年。引起癫痫的病因 :脑发育不全 7例 ,脑血管畸形4例 ,头部外伤后 15例 ,脑炎后 5例 ,有出生后窒息史者 4例 ,不明原因者 14例。癫痫发作类型 :全身性强直、阵挛发作 2 0例 ,局限性上肢或下肢抽搐扩展至全身性发作 16例 ,失神性小发作 7例 ,感觉性复杂部分性…     

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.     

Monitoring motor function during resection of tumours in the lower brain stem and fourth ventricle

Objectives Even in the days of modern microsurgery, the removal of a brain stem lesion remains a surgical challenge. Especially when operating on children, the prognosis is directly related to the radicality of the resection; however, a radical resection is often associated with surgical morbidity. Intraoperative neuromonitoring could help to minimise the surgical morbidity, but few studies have been performed to clarify the value of this monitoring. We investigated a prospective series of 21 patients with lesions involving the brain stem for the prognostic value and benefits of neuromonitoring.Methods We performed intraoperative neuromonitoring of cranial nerve function by electromyography (EMG) and motor evoked potential (MEP). The results were correlated with postoperative neurological deficits.Conclusions There is a good correlation between intraoperative neurophysiological events and postoperative neurological deficits in patients with lesions of the brain stem. In general, transient, prolonged, spontaneous activity in EMG is associated with a transient paresis of the respective muscle, whereas a permanent spontaneous activity is associated with a permanent deficit. Intraoperative neuromonitoring reliably predicts postoperative neurological function in patients with tumours of the lower brain stem and fourth ventricle. This neuromonitoring guides the neurosurgeon in the operation and may decrease surgical morbidity. We recommend using monitoring of MEP and EMG of the lower cranial nerves in surgery on all patients with lesions involving the lower brain stem and fourth ventricle.     

脑干及其附近手术诱发电位术中监护的研究

目的 探讨脑干及其周围手术损伤与脑干听觉诱发电位（ＢＡＥＰ）和体感诱发电位（ＳＥＰ）不同指标之间的关系,找出神经功能损伤第三的电生理指标。方法 对２３例脑干肿瘤病人进行手术中ＢＡＥＰ和ＳＥＰ连续监测。结果 脑干及其周围手术操作均可以引起ＢＡＥＰ、ＳＥＰ的改变。ＳＥＰ的Ｎ１３－Ｎ２０中枢传导时间（ＣＣＴ）和Ｎ２０潜伏期及波幅的变化和ＢＡＥＰＶ波潜伏期（ＰＬ）、Ⅲ－Ｖ、Ｉ－Ｖ峰间潜伏期（ＩＰＬ）的变化     

Early surgery of hamartoma of the floor of the fourth ventricle: a case report

Epilepsy from hamartoma of the floor of fourth ventricle (HFFV) is very rare, starting in neonate or infantile period, good response to surgery. We report a 3-month-old boy with episodes of medically intractable abnormal eyelid blinking and hemifacial seizure. The episodes began from the first day of life and were unresponsive to medication. A magnetic resonance imaging scan revealed mass lesion on the floor of fourth ventricle, with extended cerebellar peduncle and cerebellar hemisphere. Surgery had been performed two times previously for treatment; only a subtotal resection was performed due to severe bradycardia during the first operation. The patient underwent second operation for gross total removal of tumor. Complete resection of the mass after second surgery resulted in remission of seizures and histopathology revealed hamartoma with hemangiomatous vessel proliferation. Identification of characteristic semiology and associated HFFV can help prediction of intractability even in infant and favoring surgical treatment in early age. To our knowledge, this is the youngest patient who underwent early surgery just after progressing into status for HFFV, showing complete lesion resection resulting in successful seizure outcome.     

脑干听觉诱发电位在脑干肿瘤术中监护

目的：研究双耳刺激、双侧记录的脑干听觉诱发电位在脑干肿瘤手术中的监护价值。方法：对３０例听力正常的健康受试者用双耳刺激、双侧记录和单耳刺激、同侧记录的方法检测其脑干听觉诱发电位；对１６例脑干肿瘤患者，用双耳刺激、双侧记录的脑干听觉诱发电位进行术中连续监护。结果：所有病人在手术操作时，均出现ＢＡＥＰｓ改变，按其改变程度大致可分为轻度改变、中度改变和重度改变三种。轻、中度改变者，临床效果良好；重度改变者，预后不良，甚至死亡。结论：双耳刺激双侧记录的ＢＡＥＰｓ更适用于手术中监护；术中ＢＡＥＰｓ改变程度能反映脑干功能受影响程度和能预测预后；Ⅲ波和／或Ｖ波的ＰＬ，Ⅰ－Ⅲ、Ⅰ－Ⅴ、Ⅲ－Ⅴ的ＩＰＬ延长超过１．５ｍｓ，或者全部波形消失，是脑干功能受到不可逆损害的具体指标     

彩超在脑肿瘤切除术中的应用

目的 探讨手术中彩超辅助脑肿瘤切除的临床意义.方法 对术前影像学诊断为颅内肿瘤的29例患者术中采用脑皮层彩超探测肿瘤及其比邻关系,显现肿瘤位置、范围、瘤体内部结构,明确肿瘤毗邻血管关系结构,确定脑皮层切口入路;并术中实时监控瘤体切除范围,术后再次探测有无肿瘤残留. 结果 29例患者术中超声探测肿瘤显现率为100%,均根据彩超探测的肿瘤范围选择手术入路.脑膜瘤因血供丰富,并常与窦腔关系密切,术前探测血供情况及窦壁可能侵蚀情况,为血供断流和术中快速修补提供依据,并缩短手术时间.胶质瘤切除中,特别是功能区胶质瘤切除时,应多次探测手术切除范围与残留组织,最大限度地切除肿瘤. 结论 术前彩超可准确定位肿瘤组织,提示最佳的手术入路.术中彩超辅助脑肿瘤切除,可提高手术安全性,减少创伤性.     

Intraoperative transcranial facial motor evoked potential monitoring in surgery of cerebellopontine angle tumors predicts early and late postoperative facial nerve function

ObjectiveWe propose a novel method that predicts facial nerve function (FNF) calculated from the drop and recovery of facial motor evoked potential (FMEP) amplitude ratio during the surgery of cerebellopontine angle tumors.MethodsWe enrolled 73 patients with cerebellopontine angle tumor, and used a biphasic, constant current, and suprathreshold stimulation (BCS) protocol to record FMEP of the orbicularis oris. We measured the intraoperative minimum-to-baseline amplitude ratio (MBR), the final-to-baseline amplitude ratio (FBR), and the recovery value (RV). RV was measured by subtracting MBR from FBR. Using those values, we evaluated FNF both at early postoperative (EP) and late postoperative (LP) periods.ResultsWe successfully obtained 62 FMEP readings. Facial palsies occurred in 22 patients during the EP period, and 14 patients recovered during the LP period. Both MBR and FBR showed a significant correlation with FNF in the EP period. RV showed a good predictive power of FNF recovery during the LP period for the first time.ConclusionsRV is a new and useful predictor of FNF recovery. MBR can be an intraoperative predictor of FNF in the EP period.SignificanceFNF outcome in the early and late postoperative periods can be predicted by FMEP.     

神经电生理监测桥小脑角手术的研究(附106例报告)

目的探讨桥小脑角(CPA)手术中行神经电生理监测的意义。方法对106例CPA肿瘤病人进行了术中神经电生理监测,主要包括面神经、三叉神经、后组颅神经以及健侧脑干听觉诱发电位(BAEP)监测,观察术后面神经功能及并发症。结果面神经解剖保留96例(91%),面神经功能Ⅰ、Ⅱ级57例(54%),Ⅲ、Ⅳ级42例(40%),Ⅴ、Ⅵ级7例(6%)。术中健侧BAEP变化最明显的是Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间潜伏期。结论在CPA手术中,采用诱发电位、肌电图实时监测,可及时为术者提供脑干功能的情况;术中健侧BAEP的Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期是重要监测指标;术中肌电图监测可以提示颅神经的位置和走行,为手术时避免损伤神经提供依据。     

Intraoperative MRI for interventional neurosurgical procedures and tumor resection control in children

Introduction Despite the introduction of neuronavigational systems, radical tumor removal is still problematic in many neurosurgical procedures. Thus, direct intraoperative imaging for tumor resection control was implemented with an intraoperative magnetic resonance imaging (ioMRI) scanner installed in the operating room. Whereas most procedures with ioMRI were carried out in adults, we summarize 7 years of experience using ioMRI in children for interventional neurosurgical procedures or for tumor resection control.Method An open magnetic resonance scanner (Magnetom Open 0.2 T) was installed in the neurosurgical operating room. For tumor resection control, ioMRI was performed in 35 procedures. After the ioMRI scans were analyzed with respect to quality, the identification of residual tumor was considered by the attending neuroradiologist and neurosurgeon. If residual tumor tissue was present, a new three-dimensional (3D) dataset was acquired to update the neuronavigation; subsequently, the tumor resection was extended. In all these procedures, the results of the ioMRI were checked by an early postoperative high-field magnetic resonance imaging (MRI) study. In addition, ioMRI was carried out in ten other children to monitor interventional neurosurgical procedures.Results In all children, ioMRI was adequate both for tumor resection control and monitoring of interventional procedures. Primary radical removal of tumor was reached in 40% as confirmed by ioMRI, but in 60% of the patients, the tumor resection procedure was extended after residual tumor was detected using the new 3D dataset for navigational update. By using ioMRI, radical tumor removal improved up to 83% as confirmed by early postoperative MRI. Procedure-related complications were not seen in our series. For all MR-guided biopsies, histology findings could be confirmed, and aspiration of intracranial cysts or abscesses could be monitored online.Conclusion IoMRI using the open magnetom is suitable for detecting residual tumor tissue, can compensate for the phenomenon of brain shift using a new intraopertive 3D dataset for extended tumor resection, and is capable of monitoring interventional neurosurgical procedures. By using ioMRI for tumor resection control, the degree of tumor resection could be significantly improved.