SEP、EMG监测在岩斜区脑膜瘤手术中的应用  

Application of intraoperatively monitoring somatosensory evoked potential and electromyogram to the microsurgery for petroclival meningiomas

作　　者：张世彬[1] 钟永林[1] 李明荣[1] 陈景宇[1] 林江凯[1] 冯华[1] 吴国材[1] 

机构地区：[1]第三军医大学西南医院神经外科,重庆400038

出　　处：《中国临床神经外科杂志》2011年第2期65-68,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨术中体感诱发电位(SEP)和肌电图(EMG)联合监测技术在岩斜区脑膜瘤显微手术切除过程中的应用。方法对46例行显微手术切除岩斜区脑膜瘤患者进行术中下肢SEP监测及眼轮匝肌、口轮匝肌、咀嚼肌和斜方肌EMG监测,并将术中监测记录与麻醉后、手术开始前的记录进行比较,SEP潜伏期延长10%或波幅下降50%,EMG出现异常高电压作为预警参考值。结果 46例患者中,34例(74%)患者术中SEP监测到病变切除后潜伏期缩短超过3%或/波幅上升超过10%;7例(15%)无明显变化;5例(11%)潜伏期在安全范围,波幅下降到麻醉诱导时的30%。46例(100%)患者术中EMG均记录到不同程度的异常高电压,均根据情况调整手术方案,术毕EMG监测结果示异常放电均消失;术前25例眼胀、耳呜、面部疼痛较重患者术后症状均得到明显改善,6例无明显改变甚至呛咳增加、视力下降、复视更严重,3月后复查6例患者症状均得到改善;余术前症状不明显者,术后无明显变化。结论 SEP和EMG联合监测可最大程度避免颅神经损伤,保护神经功能,降低手术风险。Objective To study the value of intraoperatively monitoring somatosensory evoked potential （SEP） and electromyogram （EMG） to the microsurgery for the petroclival meningiomas. Methods SEP of the lower extremity and EMG of musculus orbieularis oculi, sphincter oris, masseter and trapezius were monitored during the microsurgery in 46 patients with petroclival meningiomas. The intraoperative SEP and EMG were compared with postanesthesia and preoperation those, which were considered as the basic line. The increase in the latent phase of SEP by 10% over its basic line or the decrease in the amplitude of SEP by 50% under its basic line and the abnormal high amplitude of EMG during the operation were considered as early warning signal. Results The decrease in latent phase of SEP by more than 3% under its basic line or increase in the amplitude of SEP by more than 10% over its basic line in 34 patients, the unchanged latent phase and amplitude of SEP in 7 patients, and the decrease in the amplitude of SEP by 70% under its basic line and insignificantly unchanged latent phase in 5 patients were observed during the operation. The operative plans were revised in all the patients because the abnormal high amplitudes of EMG were observed during the operation. Of 46 patients with petroclival meningiomas, 35 received total resection of the tumors and 11 subtotal. The symptoms were obviously improved in 25 patients, were unchanged in 15 patients and worsened in 6 patients in whom the symptoms were improved 3 months after the operation. Conclusion The side injury induced by the surgery may be decreased by monitoring SEP and EMG.

关 键 词：体感诱发电位 肌电图 术中监测 岩斜区脑膜瘤 

分 类 号：R739.45[医药卫生—肿瘤] R651.11[医药卫生—临床医学]