神经电生理监测在儿童及青少年脊髓栓系综合征患者手术中的应用  

Intraoperative neurophysiological monitoring in children undergoing tethered cord surgery

作　　者：方媛[1] 陈文静[1] 兰燕[2] 鞠延[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]四川大学华西医院手术室,成都610041

出　　处：《中华医学杂志》2015年第21期1659-1662,共4页National Medical Journal of China

摘　　要：目的 探讨术中神经电生理监测技术在脊髓栓系综合征（TSC）的手术中的应用价值.方法 回顾性分析2014年1至12月于四川大学华西医院神经外科行手术治疗的37例TSC儿童及青少年患者,神经电生理监测在显微手术中的应用.全部患者术前均经MRI证实为脊髓栓系综合征,在神经电生理监测下行脊髓栓系综合征松解手术,术中持续监测自发肌电图,触发肌电图定位神经根,经颅运动诱发电位评估运动系统功能完整性.结果 所有患者均成功定位神经根;32例（86.5％）诱发出经颅运动诱发电位,术后无一例经颅运动诱发电位消失或显著下降,14例（43.8％）经颅运动诱发电位波幅显著升高.全部病例术后临床症状均无加重.结论 显微手术中神经电生理监测定位技术能鉴别正常神经组织和栓系因素,经颅运动诱发电位能在术中实时评估运动系统神经功能完整性,联用两种技术能促进手术安全性,降低术后并发症的发生.Objective To retrospectively explore the multimodal intraoperative monitoring （IOM） technique during untethering cord procedures in 37 patients between l month and 16 years of age with tethered cord syndrome during 2014.Methods All patients were diagnosed as tethered cord syndrome by clinical manifestations and verified by magnetic resonance imaging （MRI）.Free and trigger electromyogram （EMG） and transcranial motor-evoked potentials （tcMEP） of extremity muscles and anal sphincters were used to map the nerves and monitor the functional motor integrity continuously.Results The monitorability rate was 100 % for nervous mapping,86.5% （32/37） for extremity muscle tcMEP.In all patients,tcMEP remained stable during surgery,43.8% （14/32） patients showed a significant postoperative increase of amplitude of tcMEP,none of them patients presented a significant and yet transient neurological worsening.Conclusion The combined technique of monitoring and mapping may boost the procedural safety,minimize the long-term morbidity and improve the clinical outcomes.

关 键 词：神经管缺损 术中神经电生理监测 显微外科手术 儿童 青少年 

分 类 号：R726.5[医药卫生—儿科] R741.044[医药卫生—临床医学]