脊髓手术中体感诱发电位监测的临床研究

报告３０例脊髓手术中体感诱发电位（ＳＥＰ）连续监测的临床研究结果。ＳＥＰ记录包括脊髓ＳＥＰ（ＳＳＥＰ）和皮层ＳＥＰ（ＳＣＥＰ）。麻醉药物对ＳＥＰ有一定程度影响，ＳＣＥＰ相对较大。认为，至少术中ＳＥＰ潜伏期延长不超过８％和波幅降低不超过５０％，不会引起术后并发症，超过该范围由于病例较少，尚不能肯定与预后的关系，需进一步探讨。     

Chiari畸形并脊髓空洞术中体感诱发电位联合诱发肌电图监测

目的评价体感诱发电位（SEP）联合诱发肌电图（EMG）监测在Chiari畸形并脊髓空洞显微手术中的保护作用。方法对23例Chiari畸形并脊髓空洞病人行术前、术中和术后SEP及EMG全程监测，术中随时将监测到的信息反馈给术者．据此及时调整操作。结果术中监测SEP以波幅较基准电位下降不超过50％，潜伏期延长不超过10％为安全范围；EMG以自发性肌电图无翻激性强直放电为安全范围。术后无严重并发症发生。结论Chiari畸形并脊髓空洞显微手术中行SEP和EMG全程监测．能及时反映脑干及脊髓功能的变化，提高操作安全性，减少并发症。     

体感诱发电位在神经外科手术中的应用

神经电生理术中监测技术的不断发展,提高了手术成功的机率,降低了致残率,极大地改善了患者的预后,越来越多地应用于临床手术。体感诱发电位作为其中的重要组成部分,在脊髓和大脑重要功能区部位手术时有很高的应用价值,而如何规范及拓展其在神经外科手术监护中的应用,使之更准确反应神经功能的实时变化,则成为目前的研究焦点。     

脊髓手术中诱发电位监测

本文介绍了近年来发展的经颅电或磁刺激运动诱发电位、多点记录的躯体感觉诱发电位、脊髓诱发电位、诱发肌电及神经干诱发电位等脊髓传导通路的监测技术;并对术中诱发电位监测的目的、脊髓病变手术中诱发电位的改变作了综述。其中以经颅电刺激运动诱发电位和多点记录的体感诱发电位较适合我国国情。     

脊髓运动诱发电位监测在手术中的应用

目的 评价脊髓运动诱发电位监测在脊柱脊髓手术中的作用.方法 通过连续短脉冲头皮电刺激,应用硬膜外电极于脊髓记录18例脊柱脊髓疾病患者手术过程中的运动诱发电位.根据日本整形外科协会(JOA)评分标准对患者手术前后神经功能进行评价.结果 以手术中首次记录到的脊髓运动诱发电位D1波波幅和潜伏期作为参照值,8例脊柱侧弯患者施行脊柱矫形手术过程中记录到的脊髓运动诱发电位D1波波幅和潜伏期均无异常变化;10例行椎管内及脊髓手术患者,手术中脊髓运动诱发电位D1波波形改变、波幅降低,改变手术方向或经短暂休息后恢复正常.根据JOA评分,手术后所有患者感觉和运动功能均较手术前明显改善,差异有统计学意义(Z=-2.646,P=0.008;Z=-2.828,P=0.005).结论 手术中脊髓运动诱发电位监测可及时、客观地反映神经功能,有效避免手术中神经损伤及手术后神经功能障碍.在监测过程中,头皮电刺激记录到的脊髓运动诱发电位D1波波形清晰、稳定,且不受外界因素的影响.     

运动诱发电位联合体感诱发电位监测在脊髓髓内肿瘤手术中的应用

目的 探讨全静脉麻醉下运动诱发电位(MEP)联合体感诱发电位(SEP)术中监测应用于脊髓髓内肿瘤手术的优越性、可靠性及临床应用价值.方法 对72例脊髓髓内肿瘤患者术中行SEP和MEP联合监测,参照McCormick评分标准对术前、术后脊髓功能的改变和诱发电位变化之间的关系进行统计分析.结果 14例脊髓神经功能改善,18例术后脊髓神经功能下降者与诱发电位监测结果具有一致性(P＜0.05).结论 对脊髓髓内肿瘤手术进行SEP与MEP监测有利于避免"假阴性/假阳性"结果及术后神经功能障碍的发生.     

神经电生理监测在圆锥马尾手术中的应用

术中神经电生理监测可在手术中实时了解神经功能完整性,鉴别神经结构和非神经结构,帮助术者减少医源性神经损伤和手术并发症,已逐渐成为神经外科手术中不可缺少的监测手段。圆锥马尾区手术易造成病人下肢感觉功能、运动功能、大小便功能及性功能障碍。本文就术中神经电生理监测在圆锥马尾手术中的应用进行综述。     

体感诱发电位动态监测在神经外科手术中保护运动功能的应用

目的探讨体感诱发电位(SEP)监测技术在神经外科手术中保护运动功能的临床应用价值。方法对54例神经外科患者手术中实时监测SEP,当术中波形发生异常变化时调整手术操作以改善SEP,评估发生各型变化的患者术后运动功能情况。分析对比术中、术毕SEP变化与术后肌力的改变,并应用χ2检验进行统计学分析。结果术中36例患者出现Ⅰ型SEP变化,其中34例患者术后肌力未见明显异常,2例患者肌力较前减退;7例患者出现Ⅱ型SEP变化,术后均未出现运动功能障碍;5例患者出现Ⅲ型SEP变化,术后均出现肌力减退;6例患者出现Ⅳ型SEP变化,术后5例患者出现肢体完全偏瘫。术中术毕SEP无变化组肌力下降率显著低于变化组。结论在神经外科手术中动态监测SEP能实时发现神经功能损伤,便于术者及时采取措施保护神经功能。根据SEP的改变还有助于预测患者术后的运动功能。     

颈髓手术中正中神经体感诱发电位监测的临床研究

目的：研究体感诱发电位（ＳＥＰ）监测在颈髓手术中的可行性和可靠性。方法：选择３４例颈髓手术病例,对两侧正中神经分别进行刺激,记录相应ＳＥＰ的Ｎ２０波形。若术中Ｎ２０发生明显变化（潜伏期延长超过１ｍｓ或波幅降低超过５０％）,即通知术者调整操作。结果：有４例因疾病的影响记录不到波形而放弃监测;在进行监测的３０例中,出现２例假阴性,无假阳性发生,术中ＳＥＰ变化与术后神经功能改变有明显的相关性（Ｐ〈０．０１）。结论：颈髓手术中,尽管可能出现假阴性结果,ＳＥＰ仍是一种比较可靠的特异性很高的神经生理监测方法。     

体感脊髓诱发电位在脊髓损伤中监测的实验研究

体感脊髓诱发电位在脊髓损伤中监测的实验研究菅凤增刘树山沙成姜宏志袁庆国一、材料与方法实验用Ｗｉｓｔａｒ大鼠４２只，雌雄不拘，体重２７５～４００ｇ，水合氯醛（３５０～４００ｇ／ｋｇ）腹腔麻醉后，动物置腹卧位，暴露下胸两节段脊髓硬脊膜，并在硬脊膜外头尾端...     

术中皮质体感诱发电位与电刺激术定位脑功能区

目的探讨脑功能区手术中利用脑皮质体感诱发电位(SEP)及直接皮质电刺激定位脑功能区的方法及意义。方法对10例脑功能区病变病人在唤醒麻醉下进行手术，利用皮质SEP及皮质直接电刺激定位感觉区、运动区及语占区，住保护脑功能区的前提下，手术切除病变。结果7例病人利用SEP及皮质电刺激确定出运动感觉区，其中4例利用SEP位相倒置确定出中央沟，3例病变位于左侧额颞叶的病人通过皮质直接电刺激确定出语言区?术后功能均较术前明显好转。结论术中SEP及直接皮质电刺激可准确、实时确定脑功能区，最大程度地保护功能，切除病变。     

体感诱发电位在复杂动脉瘤血管架桥及重建术中的应用

目的探讨体感诱发电位（SEP）在复杂动脉瘤血管架桥及重建手术中的应用。方法回顾分析2002～2008年24例复杂动脉瘤病人进行动脉瘤血管架桥及重建手术,术中分别采用动脉瘤切除远近端血管吻合,动脉瘤孤立加大隐静脉高流量搭桥或颞浅动脉低流量搭桥等方式处理动脉瘤,实时进行体感诱发电位监测：胫后神经刺激,记录双侧皮层的SEP。将P40波幅下降一半作为脑缺血的预警信号,潜伏期延长3ms作为参考。结果4例行动脉瘤切除远近端血管吻合,16例行大隐静脉高流量血管搭桥术,4例行颞浅动脉低流量血管搭桥。监测结果：Ⅰ型无变化16例;Ⅱ型加重但逐渐恢复：波幅下降一半,但稳定且略有回升4例;Ⅲ型加重无恢复：波幅下降一半,且继续下降,升高血压也无明显改善3例;Ⅳ型波形扁平且无恢复1例;Ⅴ型波形消失0例。结论在复杂动脉瘤手术中,术中体感诱发电位的监测可以提示血流阻断后脑供血情况及功能区脑灌注状态。对颅内动脉瘤手术的安全性提供了一定的保障,减少了手术风险,是一种简便、安全有效的监测技术。     

体感诱发电位监测技术在脑深部病变导航手术中的初步应用

目的初步探讨体感诱发电位(SEP)监测技术辅助神经导航手术治疗脑深部病变的应用价值。方法回顾性分析23例脑深部病变的临床资料,病变位于脑室和胼胝体11例,丘脑4例,基底核区2例,岛叶2例,额叶深部3例,顶叶深部1例。在应用导航指导病灶切除的同时实时监测SEP。当术中波形发生明显异常时即通知术者调整或停止操作。结果病变全切除15例,大部切除6例,部分切除2例。术中SEP正常19例,其中发生可逆性变化1例,术中无变化18例;术后肌力较术前减退2例,术后肌力下降率10.5%。术中SEP发生不可逆性变化4例,其中波幅降低2例,波幅消失2例;术后肌力较术前均减退,术后肌力下降率100%。术中SEP正常者肌力下降率显著低于术中SEP发生不可逆变化者(P=0.002)。结论 SEP监测联合神经导航技术有助于安全、精确切除脑深部病变。     

Direct spinal stimulation for intraoperative monitoring during scoliosis surgery

Intraoperative electrophysiological monitoring of the spinal cord has traditionally been done by recording somatosensory evoked potentials (SEP). There is a risk that SEPs can be unaltered when significant injury to the anterior spinal cord has occurred. The purpose of this report is to describe a simple technique for intraoperative spinal cord stimulation which monitors descending pathways in the anterior spinal cord. Stimulation occurs through needle electrodes inserted into spinous processes in the rostral surgical wound, and recordings are made from electrodes in the popliteal spaces. We report our experience in monitoring spinal instrumentation in 45 patients with idiopathic scoliosis and 20 with some form of neurological disease causing scoliosis. The neurogenic motor evoked potentials (NMEP) are stable and easily recorded from the popliteal spaces in the majority of patients. We describe the case of 1 patient with Friedreich's ataxia in whom no SEPs could be recorded, but NMEPs were used successfully for monitoring. We have found that combining traditional SEP monitoring with NMEP recording provides a safe and effective method to monitor the spinal cord during surgical procedures where it is at risk.© 1995 John Wiley &Sons, Inc.     

Short latency somatosensory evoked potential in children

The short latency somatosensory evoked potential was studied in 90 normal children of 1 month to 16 years old and 7 adults. Somatosensory stimuli were delivered through a disc electrode placed over the median nerve at the wrist joint. The uniform recording sites used were the central region of the scalp, and the seventh cervical spine or Erb's point. Reference electrodes were placed on the hand contralateral to the median nerve stimulated. Three positive peaks (P1, P2 and P3) and one negative peak (N1) were consistently recorded, a further positive peak (P4) after N1 was not always observed. The latency of each peak per 1 m body length decreased with age until 2 or 5 years of age. The latency of each peak after 2 years of age was positively correlated with the body length and arm length. The value of P1 peak latency per 1 m body length reaches adult values at an earlier rate than the value of P3 peak latency and P2-P3 latency per 1 m body length. This suggests that central lemmiscal pathways mature at a slower rate than peripheral nerve fibers. The wave form pattern of the short latency somatosensory evoked potential changed to the adult pattern at 10 years of age. The peak latency of P4 during deep sleep was slightly prolonged. In recording on infants during sleep, the EEG should be monitored to determine the stage of sleep.     

Intraoperative SEP monitoring in aneurysm surgery

Abstract

Somatosensory evoked potentials (SEP) were monitored during surgical treatment of 282 aneurysms in 226 patients. Significant SEP changes were found in 32 aneurysms (11.3%) mainly referring to accidental or intentional vessel occlusion. Response to these changes included reapplication of aneurysm clips, repositioning of retractors, or removal of temporary clips as followed in 23 cases (8.1%). Stable SEP signals allowed the surgeon to proceed with the surgical course and coincided in all but 2 cases (0.7%) with an uneventful outcome. Despite the limitations of SEP monitoring in certain anatomical locations, it has been found to be helpful in the operative management of some cases such as multilobed aneurysms, giant aneurysms trapping procedures, and procedures requiring temporary vessel occlusion. [Neurol Res 1994; 16: 20-22]     

应用视觉诱发电位术中监测视觉功能的研究

目的评价视觉诱发电位(VEP)在切除累及视路病灶的手术中监护视觉功能方面的可行性和可靠性。方法回顾分析31例累及视路病变的患者的临床资料,全静脉麻醉后手术,用2.1Hz的闪光二极管刺激患者,通过头皮(29例)或皮层(2例)记录视觉诱发电位,分析术中诱发电位的变化与术后视觉功能变化的关系。结果 25例患者描记出清晰、可重复的波形;VEP异常或消失的患者有7例,术后视力下降2例,视野缺损加重6例;8例术中出现VEP波形的异常,予及时改变手术策略,避免对视路的进一步骚扰后,2min内波形渐趋正常,术后仅有1例出现视野缺损。结论视觉诱发电位是一种能够提供实时视觉功能监测的可靠方法,能及时发现视路损伤。     

诱发电位监测技术在脑干及其附近肿瘤手术中的应用

目的探讨诱发电位技术在脑干及其附近肿瘤手术中的应用价值。方法选择静脉麻醉下脑干及其附近病变手术病人18例,术中监测脑干听觉诱发电位(BAEP)7例,体感诱发电位(SEP)18例,运动诱发电位(MEP)5例。当术中波形发生明显异常时,即通知术者调整或停止操作。结果本组术中诱发电位监测均顺利完成。BAEPⅤ波变化6例,其中波形逐渐恢复5例,术后均未出现新的神经功能障碍;未恢复1例,术后轻度意识障碍,3d后清醒。SEP波形变化4例,其中手术结束时恢复至基线水平3例,术后未发现异常;未恢复1例,术后病人昏迷。MEP出现变化1例,调整刺激后恢复。结论在脑干及其附近病变手术中应用多种诱发电位技术,可及时、有效地监测并保护脑干功能。     

Changes in spinal cord function evaluated by evoked potentials and spinal cord blood flow from a lateral retraction post-cervical laminectomy

We induced ischemia and stretching by retraction of the spinal cord after laminectomy in 12 anesthetized mongrel adult cats, recorded spinal motor evoked potential (SpMEP) and spinal somatosensory evoked potential (SpSSEP) and determined the spinal cord blood flow (SCBF). The results showed a correlation between progressive deterioration of the function and a decrease in SCBF. Comparing the abnormal findings of both the peak and interpeak latencies in evoked potentials, useful data were more frequently obtained using SpSSEP than SpMEP. Factors involved in their deteriorations seem to be a moderate ischemia by compression, and a stretching by the retraction of the spinal cord. From these results, we conclude that SCBF and SpSSEP are important for monitoring the impulse propagation during retraction of the cervical cord.