经颅电刺激后组脑神经运动诱发电位在颅底脑干肿瘤手术中的应用价值  

Application value of transcranial electric stimulation lower cranial nerve motor evoked potentials in skull base and brainstem surgery

作　　者：陈良鹏 王明然 王荣[2] 李达[1] 李德岭[1] 吴震[1] 张力伟[1] 贾旺[1] 张俊廷[1] 乔慧[2] 王亮[1] Chen Liangpeng;Wang Mingran;Wang Rong;Li Da;Li Deling;Wu Zhen;Zhang Liwei;Jia Wang;Zhang Junting;Qiao Hui;Wang Liang(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2022年第9期889-894,共6页Chinese Journal of Neurosurgery

基　　金：北京市属医院科研培育计划(PX2018024)。

摘　　要：目的探讨经颅电刺激后组脑神经运动诱发电位(MEPs)在颅底脑干肿瘤手术中的最佳监测方案及其应用价值。方法回顾性分析2018年12月至2019年3月首都医科大学附属北京天坛医院神经外科手术治疗的51例颅底脑干肿瘤患者的临床资料。所有患者术中均行双侧经颅电刺激后组脑神经MEPs监测,分别记录后组脑神经支配的口内、外肌群MEPs。根据术中实时阈值变化,将手术侧与非手术侧实时/基线阈值的差值>20%作为预警指标。手术前、后1个月依据曼恩吞咽功能评分(MASA)评估患者的吞咽功能,并将术后MASA分级较术前升高≥1级定义为吞咽功能恶化。采用Spearman等级相关检验分析不同肌群的手术侧与手术侧终点/基线阈值的差值与术后吞咽功能变化的相关性。绘制受试者工作特征曲线并计算曲线下面积(AUC),比较单一监测口内、口外肌群和联合监测口内-外肌群的手术侧与非手术侧终点/基线阈值的差值对术后1个月吞咽功能结局的预测价值。结果51例患者中,49例(96.1%)成功诱发MEPs。后组脑神经口内、外肌群MEPs的基线阈值、终点阈值、终点/基线阈值变化量和技术成功率的差异均无统计学意义(均P>0.05)。在监测相关并发症方面,咽后壁肌出现出血、血肿的风险明显高于环甲肌[分别为17.6%(18/102)、5.9%(6/102),P=0.009]。联合监测口内-外肌群MEPs的手术侧与手术侧终点/基线阈值的差值与术后吞咽功能恶化的相关性高于单一监测口内、外肌群(r值分别为0.74、0.62、0.63,均P<0.01)。联合监测口内-外肌群MEPs的预测价值优于单一监测口内、外肌群(AUC分别为0.94、0.87、0.87,均P<0.05)。联合监测口内-外肌群MEPs的灵敏度为89.3%,特异度为95.7%;单一监测口内肌群MEPs的灵敏度为73.3%,特异度为81.0%;单一监测口外肌群MEPs的灵敏度为80.6%,特异度为95.0%。结论联合监测口内-外肌群是颅底脑干肿瘤术中监�Objective To evaluate the optimal monitoring methodology and application value of lower cranial nerve motor evoked potentials(MEPs)in skull base and brainstem tumors surgery.Methods The clinical data of 51 patients with skull base and brainstem tumors surgically treated at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from December 2018 to March 2019 were retrospectively analyzed.All patients underwent bilateral transcranial electrical stimulation for monitoring of the MEPs of the lower cranial nerves,which were recorded in the intraoral and extraoral muscle groups innervated by the lower cranial nerves.According to the intraoperative real-time threshold changes,an increase in the difference in the real-time/baseline thresholds between the surgical and non-surgical sides by>20%was used as an early warning indicator.The patients′swallowing function was evaluated by the Mann Assessment of Swallowing Ability(MASA)before and 1 month after the operation,and the postoperative-preoperative MASA grade increase by≥1 grade was defined as the deterioration of swallowing function.Spearman′s rank correlation test was used to analyze the correlation between the changes in surgical and non-surgical endpoints/baseline thresholds and postoperative swallowing function changes in different muscle groups.The receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated to compare the prognostic values of the surgical and non-surgical endpoint/baseline threshold changes in the intraoral,extraoral,and intraoral-extraoral muscle groups for the patients′swallowing function at 1 month after surgery.Results MEPs were successfully induced in 49(96.1%)out of 51 patients.There was no significant difference in the baseline threshold,end point threshold,end point/baseline threshold change or technical success rate of MEPs in the intraoral and extraoral muscles innervated by the lower cranial nerves(all P>0.05).In terms of monitoring related complications,the risk

关 键 词：颅底肿瘤 脑干肿瘤 颅神经 诱发电位 运动 电生理学 

分 类 号：R739.41[医药卫生—肿瘤]