闪光视觉诱发电位方法学分析及其在鞍区肿瘤术中监测的初步应用

目的分析术中闪光视觉诱发电位(F-VEP)监测的相关方法学参数,并探讨其在鞍区肿瘤手术中的应用价值。方法回顾性分析2018年5月至2019年8月首都医科大学附属北京天坛医院神经外科收治的117例患者的临床资料。纳入86例椎管内占位患者(112侧眼,设为A组)进行F-VEP监测方法学参数研究。将可获得稳定F-VEP波形的参数应用于31例鞍区肿瘤患者(62侧眼,设为B组)。所有患者均在全静脉麻醉下行肿瘤切除术,并在术中行F-VEP监测,比较不同导联、不同刺激频率(0.7~1.2 Hz)下所获取F-VEP的波幅。结果A组中,在所有刺激频率下,O2-Fz或Oz-Fz导联的N75-P100峰间值(A1)均高于O1-Fz导联(均P<0.05);0.7~1.0 Hz刺激频率下,O2-Fz或Oz-Fz导联的P100-N145峰间值(A2)均高于O1-Fz导联(均P<0.05);在任一导联中,0.7~1.2 Hz范围内各刺激频率下产生的F-VEP A1的差异均无统计学意义(均P>0.05),而0.7 Hz频率下产生的F-VEP A2均高于其他频率下获得的波幅(均P<0.05)。B组中,61侧眼术中引出稳定的F-VEP波形,引出率为98.4%(61/62)。B组19例患者术中的F-VEP波形无变化,其中13例患者术后的视觉功能较术前无变化,6例患者的视觉功能有所改善。B组12例患者术中的F-VEP波形呈可逆性变化,其中4例术后视觉功能较术前无改变,7例有改善,仅1例视觉功能下降。结论选择合适的电生理刺激参数后,可在神经外科手术中获得稳定的F-VEP波形;通过在鞍区肿瘤手术中应用F-VEP监测,初步证实术中F-VEP监测结果可用于预测患者的术后视觉功能。

Methodology analysis of flash visual evoked potential and its preliminary application in intraoperative monitoring during operation of sellar region tumors

Objective To analyze the methodology parameters of intraoperative monitoring of flash visual evoked potential(F-VEP)and to explore its application value in the operation of sellar region tumors.Methods The clinical data of 117 patients admitted to Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from May 2018 to August 2019 were retrospectively analyzed.A total of 86 patients with intraductal space-occupying lesions were enrolled as A group(112 eyes)for the study of intraoperative F-VEP parameters.The stable parameters obtained from the parameter study were applied to 31 patients with sellar region tumors(B group,62 eyes).All patients underwent tumor resection and intraoperative F-VEP monitoring under general intravenous anesthesia.F-VEP amplitudes under various electrode channels and different stimulus frequencies(0.7-1.2 Hz)were compared.Results In the A group,at any stimulation frequencies,the amplitude between N75 and P100 wave(A1)of O2-Fz channel and Oz-Fz channel were significantly higher than those of O1-Fz channel(all P<0.05).At various stimulus frequencies within the range of 0.7-1.0 Hz,the amplitude of A2 of O2-Fz channel and Oz-Fz channel was significantly higher than those of O1-Fz channel(all P<0.05).In any electrode channel,A1 obtained at various stimulus frequencies within the range of 0.7-1.2 Hz did not vary significantly,while A2 at the frequency of 0.7 Hz was significantly higher than that at any other frequency(all P<0.05).In the B group,the stable F-VEP waveform was obtained in 61 eyes with an extraction rate of 98.4%(61/62).There was no change in F-VEP waveform in 19 patients in the B group,of which 13 had the same visual function as that before operation,and 6 of them had improved visual function.In the B group,among the 12 patients with reversible F-VEP waveform,4 had the same visual function as that before surgery,7 had improved visual function,and only 1 had decreased visual function.Conclusions After selecting appropriate stimulus parameters,stable and reliable F-VEP waveform can be obtained during operation.By means of preliminary application of F-VEP monitoring in sellar region tumor surgery,it has been preliminarily confirmed that intraoperative F-VEP monitoring could be used to predict the prognosis of postoperative visual function in patients.