后颅窝肿瘤术中脑干听觉诱发电位监护的临床意义

The Clinical Study on Intraoperative Monitoring of the Brainstem Auditory Evoked Potential in the posterior Cranial Fossae Operations

背景与目的:脑干是生命中枢,手术中常因损伤脑干而发生死亡或长期昏迷,完善手术中的监护,在尽可能切除肿瘤的同时及时察觉脑干的反应以避免损伤正常脑干组织,是一个迫切需要解决的问题。脑干听觉诱发电位(BAEP),是脑干及其附近手术中很好的监测方法之一,在神经外科手术中有着广泛的应用,对防止术中神经功能损伤、降低并发症及判断预后有着重要的意义。本研究目的就是检测脑干及与相应颅神经功能受损伤时较敏感的电生理指标,为后颅窝肿瘤手术提供精确、准确和安全的术中监测手段。方法:对30例后颅窝肿瘤病人。用同一进口监护仪于手术前、术中及术后分别进行BAEP连续实时监护,测定手术操作对这些指标的影响。结果:后颅窝肿瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期(PL),Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期(IPL)的明显延长(P<0.01)、Ⅴ波波幅明显降低(P<0.01),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论:BAEP的Ⅴ波潜伏期延长和波幅下降是术中敏感的电生理指标,对其进行监护,可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免病人手术后神经功能损伤。

BACKGROUND&OBJECTIVE: The brainstem is the center of the life, would be injuried intra-operatively, and would result to death or long-term coma.So it is an important thing to consummate the intra-operative monitoring, in order to resect the tumor as possible without injuring the brainstem.Brainstem auditory evoked potential (BAEP) is a very useful method to monitor the function of the brainstem, and have been used widely in neurosurgey operation, as it is an important significance to prevent the intraoperative injury, to decrease the complication, and to judge the result.The objective of this study is to detect the sensitive electrophysiological parameters on the injuries of brainstem and the responding cranial nerves, and provide the sensitive precise and safe intraoperative monitoring way for the posterior cranial fossae operations.METHODS: Thirty patients with tumors in the posterior cranial fossae were monitored with BAEP using the same monitoring machine preoperations, intraoperations and postoperations.The effects of operation on BAEP were recorded.RESULTS: All parameters of BAEP were changed after posterior cranial fossae operations.The wave Ⅰ, wave Ⅲ and wave Ⅴ latency, Ⅰ-Ⅴ and Ⅲ-Ⅴ interpeak latency were significantly increased, while the V peak was reduced during the operation.And the most significantly changed parameters were wave V latency and peak.CONCLUSION: The increase of wave V latency and reduction of V peak are the sensi- tive parameters during intraoperative monitoring of the BAEP in the posterior cranial fossae operations.The monitoring of them can provide objective parameters for the neurological injury, reduce the morbidity rate and neurological injury after posterior cranial fossae operations.