神经电生理监测下椎管内肿瘤的显微外科治疗  

Microsurgery for intraspinal tumors under electrophysiological monitoring

作　　者：张治元[1] 王汉东[1] 成惠林[1] 赵鑫[1] 林毅兴[1] 朱林[1] 

机构地区：[1]南京军区南京总医院神经外科,南京210002

出　　处：《中国临床神经外科杂志》2015年第11期668-669,672,共3页Chinese Journal of Clinical Neurosurgery

基　　金：南京军区南京总医院院管课题(2012030)

摘　　要：目的探讨神经电生理监测在椎管内肿瘤的显微外科治疗中的作用。方法 2013年5月至2015年5月显微手术治疗椎管内肿瘤49例,术中采用体感诱发电位(SEP)联合运动诱发电位(MEP)监测辅助。结果术中诱发电位结果:真阳性26例(26/29),假阳性3例;真阴性17例(17/20),假阴性3例。肿瘤全切除34例,次全切除6例,部分切除9例;无手术死亡。术后41例随访6个月至2年,神经功能改善31例(75.6%),无变化4例(9.8%),加重6例(14.6%);复发9例。结论对于椎管内肿瘤的显微外科治疗,术中采用SEP和NEP联合监测,有助于提高肿瘤全切率,减少术后并发症,改善脊髓神经功能。Objective To investigate the microsurgical treatment of intraspinal tumors under electrophysiological monitoring. Methods The Clinical data of 49 patients with intraspinal tumors, who were treated by microsurgery under somatosensory evoked potential （SEP） and motor evoked potential （MEP） monitorings, were analyzed retrospectively. Results The intraoperative e｜ectrophysiological monitoring showed that of 49 patients, 26 presented true positive findings, 3 false positive findings, 17 true negative findings and 3 false negative findings. The total removal of the tumors was achieved in 34 patients, subtotal in 6 and partial in 9. No patient died from the operation.Forty-one patients were followed up from 6 to 24 months. The neurological function was improved in 31 patients （75.6%）, unchanged in 4（9.8%）, deteriorated in 6（14.6%） and the tumors recurred in 9 patients during the following-up. Conclusions The introperative electrophysiological monitorings including intraoperative SEP and MEP monitorings is helpful to the increase in the total resection rate, decrease in the postoperative complications, and improvement of the prognoses in the patients with intraspinal tumors.

关 键 词：椎管内肿瘤 显微外科手术 术中神经电生理监测 体感诱发电位 运动诱发电位 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]