神经电生理监测下椎管内肿瘤的显微外科治疗  

Microsurgical treatment of intraspinal tumors under neuroelectrophysiological monitoring

作　　者：赵焕燕[1] 勾海超 李继华[1] 朱雁兵[1] ZHAO Huanyan;GOU Haichao;LI Jihua;ZHU Yanbing(Department of neurosurgery, Kailuan General Hospital of Hebei,Kailuan 063021,China)

机构地区：[1]河北省开滦总医院神经外科

出　　处：《现代仪器与医疗》2019年第1期33-36,共4页Modern Instruments & Medical Treatment

摘　　要：目的:观察显微外科切除椎管内肿瘤术中神经电生理监测的应用效果。方法:2015年1月至2017年12月共89例椎管内肿瘤患者在监测下完成手术。分析术中神经电生理监测应用效果及术后神经功能改善情况。结果:89例患者均在神经电生理监测下完成手术。76例为显微镜下全切术,13例为显微镜下部分切除或次全切除术。10例患者术中电生理监测未报警,79例患者术中电生理监测报警,包括躯体感觉诱发电位(SEP)报警48例,SEP与肌电图(EMG)共同报警7例,SEP与运动诱发电位(MEP)共同报警24例。36例SEP异常患者波幅降低20%~30%,立即减少牵拉刺激,10~15min后波幅恢复正常。9例患者SEP波幅降低50%以上,立即暂停手术,30~37min后SEP波幅降幅恢复至20%以下,继续完成手术。9例患者SEP波幅降低50%以上的患者术后神经症状加重,采用神经营养药物及甲基强的松龙治疗后神经症状均明显好转。术后6例患者失访,83例患者完成随访,随访时间6~23个月,平均(10.25±3.18)个月,其中73例患者神经功能改善,9例患者无明显改善,5例患者症状加重,2例患者复发。结论:神经电生理监测下椎管内肿瘤的显微外科治疗安全性及治疗效率良好。Objective: This study objective was to observe the effect of neuroelectrophysiological monitoring during microsurgical resection of intraspinal tumors. Methods: A total of 89 patients with intraspinal tumors underwent surgery under neuroelectrophysiological monitoring from January 2015 to December 2017. The effects of intraoperative neuroelectrophysiological monitoring and the improvement of postoperative neurological function were analysed. Results: All the 89 patients were operated under neuroelectrophysiological monitoring. 76 cases were total resection under microscope, and 13 cases were partial resection or subtotal resection under microscope. There were no alarms during intraoperative electrophysiological monitoring in 10 patients, and alarms during intraoperative electrophysiological monitoring in 79 patients, including 48 cases of somatosensory evoked potential (SEP) alarm, 7 cases of SEP and electromyography (EMG) alarm, and 24 cases of SEP and motion evoked potential (MEP) alarm. The amplitude of 36 patients with SEP abnormality was reduced by 20%-30%, the traction stimulus was immediately reduced, and the amplitude returned to normal after 10-15 minutes. The SEP amplitude of 9 patients was reduced by more than 50%, and the operation was immediately suspended. After 30-37 minutes, the SEP amplitude decreased by less than 20%, and the operation was continued. In 9 patients, the SEP amplitude was reduced by more than 50%, and the postoperative neurological symptoms were aggravated. After the treatment with neurotrophic drugs and methylprednisone, the neurological symptoms were significantly improved. Postoperative follow-up was performed in 6 patients, and followup was completed in 83 patients for 6-23 months (mean 10.25±3.18 months). Neurological function was improved in 73 patients, with no significant improvement in 9 patients, worsening symptoms in 5 patients,and recurrence in 2 patients. Conclusions: The microsurgical treatment of intraspinal tumors under neuroelectrophysiological monitoring is safe

关 键 词：椎管内肿瘤 显微外科 肌电图 运动诱发电位 体感诱发电位 

分 类 号：R744[医药卫生—神经病学与精神病学]