高频多脉冲直接电刺激在运动区病变切除术中的应用  

Application of high frequency multi-pulse direct electric stimulation during resection of motorcortex area disease

作　　者：王明达[1] 乔慧[1] 刘莉[1] 王明然[1] 

机构地区：[1]首都医科大学北京市神经外科研究所,100050

出　　处：《中华神经外科杂志》2015年第4期341-344,共4页Chinese Journal of Neurosurgery

摘　　要：目的 探讨高频多脉冲直接皮质电刺激运动诱发电位（dcMEPs）、皮质下电刺激运动诱发电位（scrtMEPs）及持续dcMEPs监测在皮质运动区病变切除手术中的应用意义.方法 回顾性分析2013年6月至2014年7月首都医科大学附属北京天坛医院神经外科收治的48例皮质运动区占位性病变患者,刺激前应用体感诱发电位（SEP）翻转定位中央沟,然后应用dcMEPs定位运动区、scrtMEPs测定皮质脊髓束,并采用持续dcMEPs监测以协助皮质运动区病变的切除,以术后3个月患者的运动障碍为评价指标,结合肌肉复合动作电位（CMEP）比较CMEP有不同程度下降患者的神经功能损伤情况.结果 11例CMEP波幅下降≥50％,其中9例遗留永久性运动障碍;27例CMEP波幅下降＜50％,其中3例遗留永久性运动障碍.以CMEP波幅下降50％为界线将患者分为两组,两组遗留永久性运动障碍者经,检验,差异有统计学意义（P＜0.001）.该结果提示,CMEP波幅下降≥50％,预示术后永久性运动障碍;CMEP波幅下降＜50％,预示术后运动功能正常或短暂性运动障碍.结论 dcMEPs和scrtMEPs是确定大脑皮质功能区及皮质下运动传导通路重要的定位手段;持续dcMEPs监测是术中保护皮质功能区及皮质脊髓束的重要手段,可用于协助功能区病变的手术切除及预测术后运动功能。Objective To determine the significance of the application of high frequency multipulse direct cortical-stimulated motor evoked potentials （dcMEPs）,subcortical-stimulated motor evoked potentials （scrtMEPs） and continuous dcMEPs monitoring during the resection of motor cortex area diseases.Methods Between June 2013 and July 2014 in Beijing Tiantan Hospital,Capital Medical University,we used somatosensory evoked potential（SEP） phase reverse to locate the central sulcus,and used dcMEPs to locate the eloquent cortex,scrtMEPs to determine the corticospinal tracts and continuous dcMEPs monitoring in 48 patients during surgery in and around the motor cortex area.The relationship between disability of 3 month after the surgery and the changes of compound muscle action potential （CMEP） were examined.Results The CMEP amplitude of 11 patients declined ≥ 50%,of which 9 patients had permanent motor deficit after the operation.The CMEP amplitude of 27 patients declined 〈 50%,of which 3 patients had permanent motor deficit after the operation.Using 50 % of baseline amplitude criteria,the difference in permanent movement deficit between two groups was statistically significant by 2 analysis（P 〈 0.001）.When the decline of CMEP amplitude was ≥50%,it predicted the permanent postoperative motor deficit and when the decline of CMEP amplitude was 〈 50%,it predict normal or transient motor deficit.Conclusions DcMEPs and scrtMEPs could locate the motor cortex and corticospinal tracts.The continuous dcMEPs monitoring could provide continuous monitoring of motor nerve function.The CMEP change could predict motor function after surgery.These methods should be used to assist the resection of motor cortex area diseases.

关 键 词：电刺激 诱发电位 运动 运动皮质 

分 类 号：R651[医药卫生—外科学]