应用视觉诱发电位术中监测视觉功能的研究

Study on intraoperative visual evoked potential to monitoring optical function

目的评价视觉诱发电位(VEP)在切除累及视路病灶的手术中监护视觉功能方面的可行性和可靠性。方法回顾分析31例累及视路病变的患者的临床资料,全静脉麻醉后手术,用2.1Hz的闪光二极管刺激患者,通过头皮(29例)或皮层(2例)记录视觉诱发电位,分析术中诱发电位的变化与术后视觉功能变化的关系。结果 25例患者描记出清晰、可重复的波形;VEP异常或消失的患者有7例,术后视力下降2例,视野缺损加重6例;8例术中出现VEP波形的异常,予及时改变手术策略,避免对视路的进一步骚扰后,2min内波形渐趋正常,术后仅有1例出现视野缺损。结论视觉诱发电位是一种能够提供实时视觉功能监测的可靠方法,能及时发现视路损伤。

Objective To evaluate the feasibility and reliability of monitoring visual function with visual evoked potential （VEP） during removal of lesions involving the visual pathway. Methods The clinical data of 31 patients with lesions involving the visual pathway were recorded VEP through the scalp （29 cases） or cortex （2 cases） with 2.1 Hz stimulation with flash diode during surgery after total intravenous anesthesia, to evaluate the relationship between VEP changes and changes in visual function after surgery, were analyzed retrospectively. Results 25 cases describe a clear and repeatable VEP waveform, VEP were abnormal or disappeared in 7 patients, visual acuity were decreased in 2, visual field defect in 6,8 of intraoperative VEP waveform became abnormal, changed surgical strategies in time to avoid further damage to the visual pathway , after 2 minutes waveform was becoming normal, after surgery only 1 patient had visual field defect. Conclusion VEP is a reliably way to provide real-time monitoring of visual function and help surgeons to make surgical decisions.