后颅窝手术中的脑干听觉诱发电位监护

在后颅窝手术中,用脑干听觉诱发电位监护听觉和脑干功能已被广泛应用。本文就脑干听觉诱发电位的基本特点及其在CPA肿瘤手术、脑干肿瘤手术、微血管减压术和颅底手术中的监护情况作一综述。     

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     

后颅窝肿瘤术中脑干听觉诱发电位监护

一、临床资料与方法 2001年2月至2002年7月间入院的后颅窝肿瘤20例,平均年龄28.6岁。行显微神经外科手术。静脉全麻,诱导用异丙酚、芬太尼、司可林,维持用异丙酚+利多卡因+氯胺酮。采用美国Nicolet Endeavor Bravo型术中监护系统进行脑干听觉诱发电位监测。所有数据采用SPSS软件,进行配对t检验。 二、结果 麻醉用药前后BAEP略有改变,麻醉后Ⅰ、Ⅲ、Ⅴ绝对潜伏期明显延长(P<0.05),平均延长0.201ms,而Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间距基本不变(P>0.05)。麻醉后20min、40min,各指标无统计学上的差异(P>0.05),麻醉后Ⅴ波     

后颅窝手术脑干听觉诱发电位监护的临床研究

目的:探讨后颅窝手术中脑干听觉诱发电位(BAEP)变化到什么程度会危及脑干功能。方法:经统计分析30例后颅窝患者术中BAEP各波波幅及潜伏期变化与术后脑干功能的关系。结果:术中BAEP波幅降低50％以上至波消失及双侧潜伏期延长与术后脑干损害显著相关。结论:后颅窝手术中持续进行BAEP监护,对指导手术操作及判断预后有十分重要的临床意义。     

脑干听觉诱发电位监护在脑干肿瘤手术中的应用研究

目的研究脑干及相应颅神经功能损伤时较敏感的电生理指标,为脑干肿瘤手术提供精确、准确和安全的术中监测手段。方法对18例脑干肿瘤病人,用同一进口监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)连续实时监护,测定手术操作对这些指标的影响。结果脑干肿瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)及Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期(IPL)明显延长(P<0.01),Ⅴ波波幅明显降低(P<0.01),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论BAEP的Ⅴ波潜伏期延长和波幅下降是术中敏感的电生理指标,对其进行监护可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免病人手术后神经功能损伤。     

脑干听觉诱发电位的Ⅴ波PL延长在听神经瘤手术监护中的应用价值

目的 探讨BAEP的Ⅴ波PL延长在听神经瘤手术中的应用价值. 方法 回顾性分析55例听神经瘤手术患者行BAEP术前检查、术中监护及术后疗效评估,分析Ⅴ波PL延长不同指标的监测结果. 结果 以Ⅴ波PL延长＞0.6 ms为标准,脑干或听神经损伤的灵敏度100％,特异度95.3％,误诊率4.7％,漏诊率0％,符合率96.4％.以Ⅴ波PL延长＞1.0 ms为标准,灵敏度58.3％,特异度97.7％,误诊率2.3％,漏诊率41.7％,符合率89.1％. 结论 BAEP监护听神经瘤手术中,V波PL延长＞0.6 ms有较高的敏感度和特异度,作为术中监护报警指标更合适.     

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     

大鼠脑桥、中脑电损伤后脑干听觉诱发电位的敏感性研究

目的 探讨大鼠脑桥、中脑电损伤后脑干听觉诱发电位(BAEP)的敏感指标.方法 SD大鼠80只,分别于左侧脑桥面丘和中脑上下丘之间深部给予电损伤,按照电流刺激量的不同各分为小剂量组(1 mA)、中剂量组(3 mA)、高剂量组(6 mA)、对照组(0 mA),每组10只,记录和比较各组电损伤前后的BAEP各指标的变化.每组取2只行病理学检查.结果 电损伤后,脑组织均有不同程度的神经元坏死等改变,损伤程度随电流量加大而增加.脑桥小剂量组BAEP的V波的PL、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,中剂量组的Ⅲ、V波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,高剂量组的Ⅲ、Ⅴ波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,伴Ⅲ、Ⅴ波的波幅下降;中脑中剂量组、高剂量组V波PL延长,Ⅰ～Ⅴ、Ⅲ～Ⅴ波IPL延长,损伤前后的差值与对照组比较,有统计学意义.结论 (1)BAEP的Ⅴ波PL可能为反映脑桥和中脑损伤的敏感指标;(2)BAEP反映中脑损伤不如脑桥敏感.

Abstract：

Objective To explore the sensitive indexes of brainstem auditory evoked potentials(BAEP)in rats exposed to electric injury in the pons and the midbrains.Methods The pones and midbrains of 80 rats were electric injured beneath the left facial colliculus and quadrigeminal bodies.In the pone group or the midbrain group,the animals were further divided into 4 groups:controls(0 mA),low (1 mA),middle(3 mA)and high electric current(6 mA)respectively,according to the amount of electrical stimulation.The indexes of BAEP were recorded and analyzed before and after injury.Results It was shown that electric injury resulted in neuronal necrosis,the extent of which tended to be designated as much more severe according to the amount of electrical stimulation.In the pone groups,the peak lantency(PL)of waves Ⅴ and the interpeak lantency(IPL)of waves Ⅰ～Ⅴ,Ⅲ～Ⅴ were prolonged at low electric current. However,the PL of waves Ⅲ,Ⅴ and the IPL of waves Ⅰ～Ⅲ,Ⅲ～Ⅴ,Ⅰ～Ⅴ were prolonged at middle and high electric current,and the amplitudes of waves V were decreased at high electric current significantly compared with the controls.In the midbrain groups,the PL of waves Vand the IPL of waves Ⅲ～Ⅴ,Ⅰ～Ⅴ at middle and high electric current were prolonged significantly compared with the controls.Conclusions The peak lantency of the waves V may be the most sensitive indexes of BAEP as to the pons and midbrains injured,but the changes of BAEP is less sensitive in midbrain than in pons.     

脑干及其周围术中诱发电位监护的实验研究

目的：为探索脑干及周围手术操作对听觉脑干诱发电位（ＢＡＥＰ）、体感诱发电位（ＳＥＰ）的影响，了解术中诱发电位实时监测的意义，进行本研究。方法：对２４只后颅窝及脑干周围手术的动物模型，采用ＢＡＥＰ、ＳＥＰ术中监护，观察了手术操作对诱发电位改变的影响。结果：对脑干及周围手术牵拉、分离、电凝均可以引起ＢＡＥＰ、ＳＥＰ的改变。ＢＡＥＰ的Ⅲ、Ⅴ峰潜伏期，Ⅰ－Ⅲ、Ⅲ－Ⅴ、Ⅰ－Ⅴ峰间潜伏期和ＳＥＰ的Ｎ２０改变均是术中监护的关键性参数。结论：对脑干及其周围作术中诱发电位监护，动态分析ＢＡＥＰ、ＳＥＰ主要波峰的变化，有利于手术质量的提高。     

听神经瘤术中面部肌肉肌电图及BAEP的监测与面听神经功能保留：400例临床研究

目的总结听神经瘤术中监测面部肌肉自发与诱发肌电图和脑干听觉诱发电位（BAEP）的经验,分析术中面、听神经解剖功能保留的方法及影响因素。方法使用美国Nicolet公司生产的Viking—Ⅳ型和Axon公司的Epoch XP型多导术中监测仪,对收治的400例听神经瘤患者进行了术中监测面部肌肉自发与诱发肌电图和BAEP。手术切除肿瘤,术后对患者进行面、听神经功能评估。结果肿瘤全切388例（97．70％）,次全切9例,死亡3例。本组病人面神经解剖保留率为95．97％,功能保留率为91．94％。术后主要并发症包括完全性永久性面瘫11例,面部麻木23例,角膜溃疡18例,耳呜29例,后经颅神经瘫痪28例,轻偏瘫3例,听力完全丧失139例。结论通过面部肌肉肌电图及BAEP的监测,可以准确判断颅神经的位置,最大程度避免颅神经的损伤。术中面部肌肉自发与诱发肌电图和BAEP监测,对听神经瘤外科手术的安全性提供了一定的保障,减少了手术的风险,使用得当可降低手术的致残率,应该成为听神经瘤手术的常规工作。     

桥小脑角肿瘤术中面、听神经监护

目的研究术中监护下桥小脑角肿瘤显微镜下切除的临床疗效。方法在41例桥小脑角肿瘤切除手术中,均进行脑干听觉诱发电位和面神经肌电图监护。结果肿瘤全切除者33例,次全切除者7例,大部切除者1例。41例患者均达到了面神经解剖保留,27例(65.9%,27/41)患者保留听力,其中14例为听神经瘤,占听神经瘤的56.0%(14/25)。结论术中脑干听觉诱发电位和面神经肌电图监护对于桥小脑角肿瘤切除术有重要的临床价值。     

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

ObjectiveTo propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study.MethodsThe proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included.ResultsWe found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery.ConclusionOur results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.     

Intraoperative Monitoring of Motor-Evoked Potentials for Supratentorial Tumor Surgery

Objective

The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery.

Methods

Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status.

Results

MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection.

Conclusions

MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.     

脑干听觉诱发电位对前庭系统性眩晕定位价值的研究

目的:探讨脑干听觉诱发电位(BAEP)对前庭系统性眩晕的定位价值。方法:对138例临床确诊的前庭系统性眩晕患者进行了BAEP的检测。结果:138例前庭系统性眩晕患者行BAEP检查有98例异常,异常率为71%,其中内耳型13/98例(13%),表现为Ⅰ、Ⅱ波各项指标的改变;脑干型48/98例(49%),表现为Ⅰ、Ⅱ波正常,Ⅲ、Ⅳ、Ⅴ波各项指标存在异常;混合型37/98例(38%),各波指标均出现改变。结论:BAEP有助于鉴别前庭周围性眩晕与前庭中枢性眩晕,在前庭系统性眩晕的临床诊断中有定位价值。     

脊髓手术运动诱发电位监护的实验研究

采用暴露犬颈胸段椎管、硬脊膜表面刺激的方法,诱发18只犬后肢的运动诱发电位(MEP)反应。当刺激强度≥2mA时,可以引出稳定的MEP反应。且反应不随强度增大而改变。40mA以下的强度不会引起脊髓损伤。1Hz以下的刺激频率对MEP反应无影响。本实验方法及其参数可用于临床脊髓手术中的运动功能监护。     

听神经瘤术中神经电生理监护的应用分析

目的研究听神经瘤术中脑干及相应颅神经功能较敏感的电生理监测手段,以达到减少伤残率及提高颅神经的解剖及功能保留率。方法对28例听神经瘤病人,用同一监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)及肌电图连续实时监护,观察手术操作对它们的影响。结果听神经瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期,Ⅰ-Ⅴ、Ⅲ-Ⅴ峰间潜伏期的明显延长(P<0.05),Ⅴ波波幅明显降低(P<0.05),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。当接近、触及、牵拉、刺激面神经时,肌电图出现突发的、双相或多相的高幅电位改变,而通过直接电刺激可定位面神经解剖,面神经的解剖及功能保留得以明显提高。结论BAEP的Ⅴ波潜伏期延长和波幅下降以及突发的双相或多相的高幅肌电图改变是听神经瘤术中敏感的电生理指标,对其进行监护,可为术中避免神经功能损伤及术后其功能预测提供客观指标,降低手术伤残率。     

听神经瘤术中面神经监测的临床应用研究

目的 研究面神经监测在听神经瘤手术中保护面神经的方法和意义。方法 将62例患者随机分为术中面神经监测(IFNM)组(32例)与非IFNM组(30例),然后比较分析两组患者术前、术后10d的面神经功能状况。结果 术后10d面神经功能Ⅰ～Ⅲ级者两组分别为26例和15例,Ⅳ～Ⅴ级者分别为6例和15例;随访后两组面神经功能Ⅰ～Ⅲ级者分别为29例和20例,Ⅳ～Ⅴ级者分别为3例和10例;两组比较差异显著。结论 面神经监测能显著提高听神经瘤术中面神经的解剖和功能保存率,提高患者生存质量。     

脑血管畸形显微神经外科治疗术中监测及辅助技术新进展

脑血管畸形在显微神经外科治疗过程中依靠术中监测技术准确定位病变并最大化保护
神经结构及功能。本文对脑血管畸形显微神经外科治疗术中监测及相关辅助技术在病变定位和功
能保护方面新进展做一简要综述。