解剖性大脑半球切除术后远期双上肢运动诱发电位的研究

Motor evoked potential of both upper extremities long term after anatomical hemispherectomy

目的对解剖性大脑半球切除术后远期患者进行双上肢运动诱发电位的研究，探讨剩余半球脑功能及运动传导通路。方法以5例解剖性大脑半球切除术后患者为研究对象，选取头部散在5点进行经颅磁刺激，取双上肢肱桡肌和拇短展肌作为靶肌分别记录肌肉静息和收缩时运动诱发电位。结果静息刺激时，部分患者患肢靶肌肉可记录到运动诱发电位。部分患者肌肉静息或收缩时刺激同一位点可同时在双侧同名肌肉记录到运动诱发电位。结论大脑半球切除术后患者存在支配同侧肢体运动的运动中枢及皮质脊髓联系的同侧传导通路，提示其患肢的运动功能有恢复的潜能。镜像运动的发生可能与双侧肢体运动皮质中枢的重叠有关。

Objective To explore the function and motor pathway of remained cerebral hemisphere by studying motor evoked potential of both upper extremities on patients long term after anatomical hemispherectomy. Methods Five patients after anatomical hemispherectomy,who were marked 5 dispersive sites on head to perform transcranial magnetic stimulation. Recording motor evoked potential of target muscles（ brachioradialis muscle and abductor pollicis brevis）of both upper extremities respectively when muscle resting and contracting. Results Only affected abductor pollicis brevis of case 2 and only affected brachioradial muscle of case 4 and 5 recorded motor evoked potential when muscle resting. Motor evoked potential of some cases can be recorded simultaneously in homonymous muscles of both sides wben muscle resting or contracting. Conclusions There exists motor cortex that controls movement of ipsilateral limbs and also ipsilateral motor pathway of corticospinal connection at patients after anatomical hemispherectomy. It also means that the motor function of affected limbs has potency to recover well after hemispherectomy. The mirror movement after bemispbercctomy is possible relate to overlap of both limbs＇ motor cortex.