术中闪光视觉诱发电位监测在儿童鞍区肿瘤中的应用  

Application of intraoperative flash visual evoked potential monitoring in children with sellar region tumors

作　　者：刘瑜 刘剑钢 王君璐 魏民 李森 肖波[1] Liu Yu;Liu Jiangang;Wang Junlu;Wei Min;Li Sen;Xiao Bo(Department of Neurosurgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院神经外科,上海200062

出　　处：《临床小儿外科杂志》2022年第10期911-916,共6页Journal of Clinical Pediatric Surgery

基　　金：上海申康医院发展中心临床研究关键项目(SHDC2020CR5004)

摘　　要：目的探讨闪光视觉诱发电位(flash visual evoked potential,F-VEP)监测在儿童鞍区肿瘤手术中的应用价值。方法回顾性分析2020年1月至2021年12月上海市儿童医院神经外科收治的20例鞍区肿瘤患儿临床资料,按年龄将患儿分为两组:1~6岁组(10例)和7~14岁组(10例),均在静脉吸入复合麻醉下行肿瘤切除术,术中行F-VEP监测,比较不同导联不同刺激频率(0.7~2.0 Hz)下F-VEP的波幅,确定合适的刺激参数及主要观察指标。于术后第14天对所有患儿进行视力检查,评估术中观察指标与术后视力的相关性,证实其应用价值。结果1~6岁组患儿中,在刺激频率(1.4 Hz)下,O1-Fz、O2-Fz、Oz-Fz三个导联F-VEP的N75-P100峰间值(A1)和P100-N145峰间值(A2)均高于其他刺激频率(0.7、1.0、2.0 Hz)下相应导联的A1、A2(P<0.05);不同导联之间比较,O2-Fz或Oz-Fz导联的A1、A2均高于O1-Fz导联(P<0.05);在任一导联中,F-VEP的A2波幅均高于A1(P<0.05)。7~14岁组中,在刺激频率(0.7 Hz)下,O1-Fz、O2-Fz、Oz-Fz三个导联的A1、A2均高于其他频率(1.0、1.4、2.0 Hz)下相应导联的A1、A2(P<0.05);不同导联之间比较,O2-Fz或Oz-Fz导联的A1、A2均高于O1-Fz导联(P<0.05);在任一导联中,A2波幅均高于A1(P<0.05)。20例鞍区肿瘤患儿中,3例F-VEP波幅值较基线升高,术后视力较术前改善;8例波形无变化,其中2例术后视力较术前改善,6例无明显改变;6例波形呈可逆性变化,先降低后升高,其中3例术后视力无明显改变,3例较术前改善;3例波形持续降低,其中2例波幅下降小于50%,术后视力无明显改变;1例波幅下降大于50%,术后视力下降。结论针对患儿年龄选择合适的电生理刺激参数,可在儿童鞍区肿瘤手术中获得稳定的F-VEP波形。术中F-VEP监测有助于避免损伤视神经、视交叉等视觉通路,可最大程度保护患儿视力,对术后视觉功能的评判有一定的临床实用价值。Objective To explore the application value of flash visual evoked potential(F-VEP)monitoring during operations of sellar region tumors in children.Methods From January 2020 to December 2021,clinical data were retrospectively reviewed for 20 hospitalized children undergoing operations for sellar region tumors.They were divided into two age groups of 1-6-year and 7-14-year(n=10 each).Tumor resection was performed under intravenous plus inhalation anesthesia and F-VEP monitoring intraoperatively.The amplitudes of F-VEP under different leads and different stimulation frequencies(0.7-2.0 Hz)were compared to determine the appropriate stimulation parameters and major observation parameters.Visual acuity was examined at Day 14 post-operation for examining the correlation between intraoperative observation parameters and postoperative visual acuity.Results In 1-6-year group,at a stimulation frequency of(1.4 Hz),the amplitude between N75-P100(A1)or N145-P100(A2)of three leads(O1-Fz,O2-Fz,Oz-Fz)were higher than any other frequency(0.7,1.0,2.0 Hz)(all P<0.05).As compared between different leads,the amplitude of A1/A2 at lead O2-Fz or Oz-Fz were higher than those at lead O1-Fz(P<0.05).At any lead,the amplitude of A2 was higher than that of A1(P<0.05).In 7-14-year group,at a stimulation frequency of(0.7 Hz),the amplitude of A1/A2 of all three leads were higher than any other frequency(1.0,1.4,2.0 Hz)(all P<0.05).As compared between different leads,amplitude of A1/A2 at lead O2-Fz or Oz-Fz were higher than those at lead O1-Fz(P<0.05).At any lead,amplitude of A2 was higher than that of A1(P<0.05).F-VEP amplitude was higher than baseline(n=3)and postoperative visual acuity improved as compared with preoperatively.In 8 cases without change in waveform,there were improved postoperative visual acuity(n=2)and no improvement(n=6).The waveforms of 6 cases showed reversible changes of initial decline and subsequent rise.Visual acuity improved(n=3)and showed no obvious changes(n=3).In 2/3 of cases with a declining waveform during operati

关 键 词：脑肿瘤 神经外科手术 神经电生理监测 闪光视觉诱发电位 治疗结果 儿童 

分 类 号：R73[医药卫生—肿瘤]