经颅磁刺激运动诱发电位和颈内动脉丙泊酚注射试验对脑运动支配评估的对照研究

Comparison of transcranial magnetic stimulation motor evoked potential and intracarotid propofol wada test for evaluation of cerebral motor cortex

目的以颈内动脉丙泊酚注射试验(丙泊酚Wada试验)为对照,探讨经颅磁刺激运动诱发电位(TMS-MEP)评估大脑半球运动支配情况的准确性,及其是否可取代丙泊酚Wada试验单独用于大脑半球运动支配情况的评估。方法选择因颅内病变拟行开颅手术可能累及运动皮层的患者全部进行TMS-MEP检查和丙泊酚Wada试验。记录两种检查方法得到的大脑半球的运动支配情况,以丙泊酚Wada试验作为评估大脑半球运动支配情况的标准技术,比较两种技术的吻合率,评价TMS-MEP检查的准确性。结果 2011年3月至2012年4月共入选10例患者,TMS-MEP与丙泊酚Wada试验的吻合率为90%,两者评价脑运动支配情况的结果无统计学差异(P>0.05)。对于其中1例TMS-MEP与丙泊酚Wada试验结果不同的患者,其运动代偿区可能位于健侧半球的辅助运动区。结论 TMS-MEP检查可用于术前运动支配情况的初步评价。对于脑运动功能区的准确定位,TMS-MEP检查需要与术前功能磁共振、脑磁图或丙泊酚Wada试验相结合,以利于制定安全的手术方案,减少手术造成神经功能永久缺失。

Objective To determine whether transcranial magnetic stimulation motor evoked potential(TMSMEP) test can replace the intracarotid propofol test(propofol Wada test) to evaluate the motor cortex.Methods A prospective,controlled clinical trial was conducted comparing TMS-MEP test with propofol Wada test for evaluation of cerebral motor domination.Patients were enrolled under strict inclusion and exclusion criteria.All patients received TMS-MEP test and propofol Wada test to calculate the fitness of two methods.Results 10 patients were enrolled from March 2011 to April 2012.90% of TMS-MEP tests wholly fit to propofol Wada tests.The results of both tests showed that there was no significant difference(Fisher' s exact test P > 0.05).There was only one patient whose results of two tests didn't meet and whose motor compensatory area might be the supplementary motor area(SMA) at the non-lesion hemisphere.Conclusions There is no significant difference between TMS-MEP test and propofol Wada test.TMS-MEP test has good fitness.There is limitation of TMS-MEP test to evaluate the interhemispheric motor compensation.The combination of TMS-MEP with functional magnetic resonance imaging(fMRI),diffusion tensor imaging(DTI),magnetoencephalography(MEG) or propofol Wada test will lead to perform more complete and precise resections of lesions while preserving neurological functions.