CAJ | 학술논문

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.
목적 탐토술중신경전생리감측기술재척수전계종합정(TSC)적수술중적응용개치.방법 회고성분석2014년1지12월우사천대학화서의원신경외과행수술치료적37례TSC인동급청소년환자,신경전생리감측재현미수술중적응용.전부환자술전균경MRI증실위척수전계종합정,재신경전생리감측하행척수전계종합정송해수술,술중지속감측자발기전도,촉발기전도정위신경근,경로운동유발전위평고운동계통공능완정성.결과 소유환자균성공정위신경근;32례(86.5％)유발출경로운동유발전위,술후무일례경로운동유발전위소실혹현저하강,14례(43.8％)경로운동유발전위파폭현저승고.전부병례술후림상증상균무가중.결론 현미수술중신경전생리감측정위기술능감별정상신경조직화전계인소,경로운동유발전위능재술중실시평고운동계통신경공능완정성,련용량충기술능촉진수술안전성,강저술후병발증적발생.
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.