脑干三叉神经诱发电位的特征及临床应用研究

The characteristics and clinical applications of the brainstem trigeminal evoked potentials

目的 探讨正常人脑干三叉神经诱发电位 (BTEP)的波形特征及三叉神经系统病变时BTEP的变化。方法 对 3 0名正常成人进行BTEP检测 ,确定正常值标准 ,并与 2 5例确诊为三叉神经系统病变患者的BTEP检查结果进行比较。结果 3 0名正常人均记录到清晰、稳定的BTEP反应波。病例组 2 5例中BTEP异常 14例 ( 5 6% ) ,其中双侧异常 6例。 9例有面部感觉障碍者中 8例BTEP异常 ,16例无面部感觉障碍者 6例异常。 5例经脑外科手术证实的脑桥小脑角肿瘤患者 4例异常。 7例行射频治疗者 ,手术前后BTEP无明显变化。周围性病变时 ,BTEP主要表现为T1、T2 波消失或潜伏期延长 ,T1～T3波波间潜伏期差值 (IPLD)延长。中枢性病变时T3、T5波消失或低波幅 ,T1～T5、T2 ～T5波IPLD延长。结论 用无伤害性刺激在正常人可引导出稳定的BTEP反应波。三叉神经系统周围神经和脑干中枢部分病变时 ,BTEP变化明显。BTEP为评价三叉神经周围结构和脑干中枢神经通路功能 ,提供了一个新的、可靠的电生理学方法。

Objective To explore the response characteristics and clinical correlations of the brainstem trigeminal evoked potentials(BTEPs) in healthy subjects and in the patients with lesions of the trigeminal system. Methods BTEPs were detected by stimulating the upper lips with electrical pulses in 30 healthy volunteers establishing the normative criteria as compared with the results of BTEP detected in 25 patients with definite lesions of the trigeminal system. Results Clear and stable BTEPs were recorded in all of the 30 healthy subjects. The frequency of abnormal BTEPs was 56%(14 cases) in 25 patients, 6 of whom had bilateral abnormal responses. Eight of the 9 cases with facial dysesthesia had pathological responses. In 16 patients without facial sensory disturbance 6 of them had abnormal BTEPs. Four cases with tumors of the cerebello pontine angles verified by operations were abnormal. In 7 cases undergoing electric coagulation of radio frequency the BTEPs were not obviously changed before and after the operations. The patients with trigeminal peripheral lesions were often associated with absence of decreased amplitude of T 1 or/and T 2 or with marked prolongation of T 2、T 3 and T 1～T 3. In cases with the lesions of the brainstem central structures the BTEPs mainly showed changes of T 3、T 5、T 1～T 5 and T 2～ T 5. Conclusion Stable BTEP can be induced and recorded by non invasive stimulation in healthy subjects. With injuries to the trigeminal system the BTEP changed obviously. BTEPs provide a new and reliable method for evaluating the functions of the trigeminal peripheral and brainstem central pathways.