CAJ | 학술논문

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.
목적 탐토고빈다맥충직접피질전자격운동유발전위(dcMEPs)、피질하전자격운동유발전위(scrtMEPs)급지속dcMEPs감측재피질운동구병변절제수술중적응용의의.방법 회고성분석2013년6월지2014년7월수도의과대학부속북경천단의원신경외과수치적48례피질운동구점위성병변환자,자격전응용체감유발전위(SEP)번전정위중앙구,연후응용dcMEPs정위운동구、scrtMEPs측정피질척수속,병채용지속dcMEPs감측이협조피질운동구병변적절제,이술후3개월환자적운동장애위평개지표,결합기육복합동작전위(CMEP)비교CMEP유불동정도하강환자적신경공능손상정황.결과 11례CMEP파폭하강≥50％,기중9례유류영구성운동장애;27례CMEP파폭하강＜50％,기중3례유류영구성운동장애.이CMEP파폭하강50％위계선장환자분위량조,량조유류영구성운동장애자경,검험,차이유통계학의의(P＜0.001).해결과제시,CMEP파폭하강≥50％,예시술후영구성운동장애;CMEP파폭하강＜50％,예시술후운동공능정상혹단잠성운동장애.결론 dcMEPs화scrtMEPs시학정대뇌피질공능구급피질하운동전도통로중요적정위수단;지속dcMEPs감측시술중보호피질공능구급피질척수속적중요수단,가용우협조공능구병변적수술절제급예측술후운동공능.
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.