ChiariⅠ型畸形手术前后的诱发电位研究

Evoked potentials research in pre-and-post operation on Chiari Ⅰ malformation

[目的]研究Chiari Ⅰ型畸形患者手术前后的诱发电位的变化规律，观察手术前脊髓空洞的程度与诱发电位变化之间的关系。[方法]对2003年10月-2004年9月收治的15例Chiari Ⅰ型畸形患者，采取寰枕减压术、硬膜成形术。手术前第1～3d和手术后第10—14d分别检测BAEP、SEP、MEP，然后对这些患者经过6个月的随访，进行脊髓功能JOA评分和MRI复查。[结果]15例Chiari Ⅰ型畸形患者手术前14例SEP、MEP异常，手术后临床症状均有所缓解，脊髓功能JOA改善率为60．3％，MRI复查显示脊髓空洞明显缩小、诱发电位SEP检测P40-N22、N20-N13潜伏期与MEP检测中枢传导时间CMCT值和BAEP检测Ⅰ—Ⅴ峰间期，三者测的值比术前均缩短，差异有显著性。同时发现Chiari畸形患者的SEP与MEP检查测得皮层值术后比术前缩短，差异有显著性，而外周神经传导时间术后与术前比较却没有任何变化。[结论]诱发电位可以作为评价Chiari Ⅰ型畸形手术前后效果的客观而相对准确的检查方法。

[ Objective] To study the change rules of evoked potentials in pre-and-post operation of Chiari Ⅰ malformation patients, and observe the relationship between the syrinxs and evoked potentials. [ Method] During the period of October 2003 to September 2004, 15 patients with Chiari I malformation were collected, which underwent suboccipital craniectomy and duraplasty. The patients＇ brainstem auditory evoked potentials and somatosensory evoked potentials and motor evoked potentials were were examined in 1 - 3 days before operation and 10 - 14 days after operation. After six months follow-up, these patients under- went MRI countercheck and JOA grade. [ Result] The clinic symptoms were relaxed in 15 cases with Chiari Ⅰ malformation. The recovery rate of JOA score was 60. 3%, and syrinx were reduced in MRI check. There was shorten of cervicomedullary central conduction time in the examine of BAEP （ Ⅰ-Ⅴ ） and SEP （P40-N22, N20-N13） and MEP （CMCT） , which has markedly difference compare to fore-operation. At the same time, we discoveried it was shorten of cortical conduction time in the examine of BAEP and SEP and MEP, however, the peripheral conduction time were not ever change. [ Conclusion] Through the method of evoked potentials, improvement of Chiari I malformation nerve function can be assessed pre-and-post operation.