术中监护下神经导航显微手术切除功能区及深部病变

Neuronavigator-guided microsurgery under intraoperative monitoring

目的研究术中监护下神经导航手术切除功能区及深部病变的疗效。方法在神经导航引导的显微神经外科手术中,对32例脑功能区及深部病变病人进行正中神经N 20、P25和胫后神经P40、N50体感诱发电位(SEP)监护,以及大鱼际肌和胫前肌运动诱发电位(MEP)监护,以指导手术操作。结果术后MR复查示均达到全切除。24例偏瘫病人中术后症状改善21例,17例癫疒间病人中癫疒间症状术后消失13例,12例失语病人中术后改善10例。术后未产生新的神经损害症状,无手术并发症及死亡。结论术中神经电生理监护对于提高脑功能区及深部区域病变的手术疗效和安全性有重要意义。

Objective To study therapeutic effect of neuronavigator-guided microsurgery under intraoperative monitoring for resection of lesions in the eloquent brain area. Methods Thirty-two patients with lesions in the eloquent brain area were monitored intraoperatively with somatosensory evoked potentials （SEP） including N20-P25 of median nerve and P40-N50 of posterior tibial nerve and motor evoked potentials （MEP） of thenar muscles and tibialis anterior muscles during neuronavigator-guided microsurgery, and thus the operative procedures were guided. Results Postoperative MRI showed that all lesions in the eloquent brain area were totally removed. The symptoms of 21 out of 24 hemiplegia and 10 out of 12 aphasia patients were relieved gradually, and in 17 epilepsy patients, the symptom disappeared completely in 13. There was no new nerve injury, complication or death postoperation. Conclusion Intraoperative neurophysiological monitoring play a significant role in improving the clinical effect and safety of neurosurgical procedure for resection of lesions in the eloquent brain area.