体感诱发电位监测技术在脑深部病变导航手术中的初步应用

Preliminary application of somatosensory evoked potential monitoring in neuronavigation-guided operations for treating deep-seated brain lesions

目的初步探讨体感诱发电位(SEP)监测技术辅助神经导航手术治疗脑深部病变的应用价值。方法回顾性分析23例脑深部病变的临床资料,病变位于脑室和胼胝体11例,丘脑4例,基底核区2例,岛叶2例,额叶深部3例,顶叶深部1例。在应用导航指导病灶切除的同时实时监测SEP。当术中波形发生明显异常时即通知术者调整或停止操作。结果病变全切除15例,大部切除6例,部分切除2例。术中SEP正常19例,其中发生可逆性变化1例,术中无变化18例;术后肌力较术前减退2例,术后肌力下降率10.5%。术中SEP发生不可逆性变化4例,其中波幅降低2例,波幅消失2例;术后肌力较术前均减退,术后肌力下降率100%。术中SEP正常者肌力下降率显著低于术中SEP发生不可逆变化者(P=0.002)。结论 SEP监测联合神经导航技术有助于安全、精确切除脑深部病变。

Objective To primarily evaluate the clinical application of somatosensory evoked potential（SEP） monitoring for neuronavigation-guided operations in treating deep-seated brain lesions.Methods Clinical data of 23 patients with deep-seated brain lesions were analyzed retrospectively,including ventricle and corpus callosum in 11 cases,thalamus in 4,basal ganglia in 2,insula in 2,deep-seated frontal lobe in 3,deep-seated parietal lobe in 1.The resection of lesions was guided by neuronavigation and real-time SEP monitoring.If SEP waveforms changed significantly,operations were modified or even stopped.Results Total resection was achieved in 15 cases,subtotal resection in 6,and partial resection in 2.Intraoperative SEP kept normal in 19 cases,including reversible change in 1,and no change in 18.The muscle strength was decreased in 2 cases postoperatively,and the rate of reduction was 10.5%.While SEP changed irreversibly in 4 cases,including wave altitude decreased in 2 and completely disappeared in 2.The muscle strength was decreased in all the patients postoperatively,and the rate of reduction was 100%.The rate of muscle strength reduction in the group with normal SEP was significantly lower than that in the group with irreversible change of SEP（P=0.002）.Conclusions SEP monitoring in combination with neuronavigation is beneficial to safety and precise resection of deep-seated brain lesions.