神经电生理监测技术在儿童脑干胶质瘤手术中的应用

Application of intraoperative neuroelectrophysiological monitoring during operations for pediatric brainstem glioma

目的探讨神经电生理监测技术在儿童脑干胶质瘤手术中的应用价值。方法回顾性分析苏州大学附属儿童医院神经外科2016年1月至2021年9月期间行术中神经电生理监测下肿瘤切除术的18例儿童脑干胶质瘤临床资料。患儿年龄1~14岁,术中实施监测项目包括脑干图(mapping)、体感诱发电位(somatosensory evoked potential,SSEP)、运动诱发电位(motor evoked potential,MEP)、脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)和肌电图(electromyography,EMG)等。观察围手术期并发症及术后6个月至6年的随访情况,记录肿瘤的影像学变化及患儿神经功能变化。结果18例患儿在术中神经电生理监测技术下成功实施手术,无一例围手术期死亡病例。术后偏瘫加重2例,经1个月康复治疗后恢复至术前水平。Karnofsky功能状态评分(KPS)由术前的(73.89±21.46)分提升至术后1个月(放化疗前)的(86.11±9.79)分,差异有统计学意义(t=3.96,P<0.01)。结论儿童脑干胶质瘤手术中辅助神经电生理监测技术具有较好的可行性和稳定性。术中神经电生理监测可有效提高脑干胶质瘤手术的安全性,有利于改善患儿长期预后。

Objective To explore the application of intraoperative neuroelectrophysiological monitoring during operations for pediatric brainstem glioma.Methods From January 2016 to September 2021,clinical data were retrospectively reviewed for 18 children with brainstem glioma undergoing operations with intraoperative neuroelectrophysiological monitoring.The age range was 1 to 14 years.The contents of intraoperative monitoring included mapping,somatosensory evoked potential(SSEP),motor evoked potential(MEP),brainstem auditory evoked potential(BAEP)and electromyography(EMG).Perioperative complications were recorded during a follow-up period of 0.5-6 years.And the changes of tumor imaging and neurological functions were analyzed.Results No perioperative mortality occurred in this series.Deteriorating lateral limb function was observed in 2 cases after operation which recovered to preoperative level with the help of rehabilitation treatment 1 month later.At one month follow-up study before radiation therapy or chemotherapy,average Karnofsky performance score was 86.11±9.79 which was significantly higher(t=3.96,P<0.01)than that before surgery 73.89±21.46.Conclusion Intraoperative neuroelectrophysiological monitoring is both feasible and stable for operations of pediatric brainstem glioma.It can effectively enhance surgical safety and improve long-term prognosis.