脑干听觉诱发电位在脑干肿瘤术中监护

Monitoring of brain stem auditory evoked potentials during brainstem tumor operation.

目的：研究双耳刺激、双侧记录的脑干听觉诱发电位在脑干肿瘤手术中的监护价值。方法：对３０例听力正常的健康受试者用双耳刺激、双侧记录和单耳刺激、同侧记录的方法检测其脑干听觉诱发电位；对１６例脑干肿瘤患者，用双耳刺激、双侧记录的脑干听觉诱发电位进行术中连续监护。结果：所有病人在手术操作时，均出现ＢＡＥＰｓ改变，按其改变程度大致可分为轻度改变、中度改变和重度改变三种。轻、中度改变者，临床效果良好；重度改变者，预后不良，甚至死亡。结论：双耳刺激双侧记录的ＢＡＥＰｓ更适用于手术中监护；术中ＢＡＥＰｓ改变程度能反映脑干功能受影响程度和能预测预后；Ⅲ波和／或Ｖ波的ＰＬ，Ⅰ－Ⅲ、Ⅰ－Ⅴ、Ⅲ－Ⅴ的ＩＰＬ延长超过１．５ｍｓ，或者全部波形消失。

Objective: To study the value of monitoring of brain stem auditory evoked potentials of binaural stimulation and bilateral recording during brainstem tumor operation. Methods: BAEPs of monoaural stimulation, ipsilateral recording and binaural stimulation, bilateral recording were determined in 30 healthy subjects with normal audition. Intraoperative monitoring of BAEPs of binaural stimulation, bilateral recording were done in 16 patients with brain stem tumors. Results: All the patients had the wave deterioration of BAEPs during surgical procedures, which could be divided into three types: slight, morderate and severe changes. The patients with slight or morderate changes of intraoperative BAEPs had satisfactory results, while the patients with severe changes had bad prognosis, even died. Conclusions: BAEPs of binaural stimulation, bilateral recording are more appropriate to be used in intraoperative monitoring. The degree of deterioration of BAEPs could reflect the dysfunction of brain stem, and could predict the prognosis. The latencies of wave Ⅲ and/or Ⅴ, or the interpeak latencies of Ⅰ Ⅲ,Ⅲ Ⅴ,Ⅰ Ⅴ of BAEPs prolonged more than 1 5 ms, or all waves of BAEPs disappeared are the signs of irreversible dysfunction of brain stem.