神经电生理监测在脑深部病变手术中的应用研究

目的探索神经电生理监测在脑深部病变手术中的作用。方法回顾性分析脑深部病变切除手术62例,使用多功能神经电生理监护仪,实施体感诱发电位、脑干听觉诱发电位、运动诱发电位、肌电图、皮质脑电图和直接皮质电刺激等,术中应用B超或无框架导航技术定位病变,尽可能全切病变。结果病灶全切除40例,次全切除22例。术后病人运动功能障碍短暂加重6例,术后3个月均恢复正常,术后神经功能立即改善45例,无明显变化11例。术后病理：海绵状血管瘤15例,脑脓肿5例,胶质瘤28例,脑寄生虫5例,脑膜瘤5例,其他4例。随访0.5～6年,平均3年,全切除病例均未见复发,次全切病例未见进展。结论使用多种神经电生理监护手段可大幅增加脑深部病变手术安全性。

Application of neuro-electrophysiological monitoring in surgery for deep-seated brain lesions

Objective To study the role of the neuro-electrophysiological monitoring in the operations for deep-seated brain lesions.Methods Clinical data of 62 patients with deep-seated brain lesions were analyzed retrospectively.These patients were operated on to resect the lesions using multimodal neuro-electrophysiological monitor for monitoring somatosensory evoked potential,brainstem auditory evoked potentials,motor evoked potentials,electromyogram,electrocorticogram and direct cortical electrical stimulation.The lesions were located by ultrasonography or frameless neuronavigation.The maximal resection of the tumors and minimal changes of monitoring parameters were the surgical goal of all the patients.Results Total lesion resection was achieved in 40 patients,and subtotal in 22.Six patients experienced transient paralysis and recovered in 3 months after operation.Postoperative neurological function was improved immediately in 45 patients,and showed no significant change in 11.Pathological findings were cavernous angioma in 15,cerebral abscess in 5,gliomas in 28,parasitic lesions in 5,meningiomas in 5 and other lesions in 4.The patients were followed up for the mean period of 3 years,ranged from 0.5 to 6 years.There is no relapse in all the total resection patients and no progress in subtotal cases.Conclusions The multimodal intraoperative neuro-electrophysiological monitoring could obviously increase the safety of the operation for deep-seated brain lesions.