诱发电位监测技术在脑干及其附近肿瘤手术中的应用

Application of intraoperative evoked potential monitoring in tumors around brainstem

目的探讨诱发电位技术在脑干及其附近肿瘤手术中的应用价值。方法选择静脉麻醉下脑干及其附近病变手术病人18例,术中监测脑干听觉诱发电位(BAEP)7例,体感诱发电位(SEP)18例,运动诱发电位(MEP)5例。当术中波形发生明显异常时,即通知术者调整或停止操作。结果本组术中诱发电位监测均顺利完成。BAEPⅤ波变化6例,其中波形逐渐恢复5例,术后均未出现新的神经功能障碍;未恢复1例,术后轻度意识障碍,3d后清醒。SEP波形变化4例,其中手术结束时恢复至基线水平3例,术后未发现异常;未恢复1例,术后病人昏迷。MEP出现变化1例,调整刺激后恢复。结论在脑干及其附近病变手术中应用多种诱发电位技术,可及时、有效地监测并保护脑干功能。

Objective To investigate the applied value of evoked potential monitoring in surgery for tumors around the brainstem. Methods In 18 patients receiving surgery for tumors around brainstem under intravenous anesthesia, brainstem auditory evoked potential （BAEP） was monitored in 7 cases, somatosensory evoked potential （SEP） in all patients, and motor evoked potential （MEP） in 5 cases. The operation should be modified or even stopped when the waveforms changed significantly. Results The electrophysiological monitoring was performed successfully in all the patients. The waveforms of BAEP changed intraoperatively in 6 patients, 5 out of them recovered gradually without new neurologic deficits occurred postoperatively, and 1 whose BAEP waveform did not recover underwent transient consciousness disturbance for 3 days. Changed waveforms of SEP were found in 4 patients, 3 out of them recovered to the baseline level at completion of the intracranial procedures with no complications postoperatively, and the other one whose SEP waveform did not recover underwent postoperative persistent coma. Changes of MEP waveforms were detected in 1 case and returned to normal after regulation of electrical stimulation. Conclusions Monitoring of multiple evoked potentials can protect brainstem functions promptly and effectively in surgery for tumors around brainstem.