SEP对颈及胸椎管内肿瘤手术脊髓功能监护作用

THE ROLE OF SOMATOSENSORY EVOKED POTENTIAL IN MONITORING FUNCTION OF SPINAL CORD AT SURGERY FOR INTRASPINAL TUMOR OF SERVICAL AND THORACIC VERTEBRAE

目的观察体感诱发电位(SEP)在颈、胸椎椎管内肿瘤切除术中对脊髓功能的监护作用。方法颈、胸椎椎管内肿瘤病人105例,椎管内肿瘤切除术中采用SEP监测脊髓功能的变化。结果 105例颈、胸椎椎管内肿瘤病人中,有8例因疾病原因术前记录不到SEP,仍坚持监护,肿瘤切除后有2例出现SEP。余97例中10例肿瘤切除时出现SEP异常,术后均有不同程度的神经症状。假阳性5例,均为术前神经症状较重,SEP波幅低、波形弥散者。出现假阴性2例,表现为术后肢体活动不灵,24h内肢体功能均恢复。结论颈、胸椎椎管内肿瘤后路手术应用SEP监测脊髓功能可即时反映脊髓的功能状态,是一种可靠的脊髓功能监护手段。

Objective To observe the role of somatosensory evoked potential（SEP） in intraoperative monitoring of spinal cord function at cervical and thoracic intraspinal tumor（IST） resection.Methods This study consisted of 105 patients suffering from cervical and thoracic IST,their spinal cord function were monitored at surgery by SEP.Results Of the 105 patients,SEP was failed to be recorded in eight patients prior to surgery due to the disease,but the monitoring remained.Postoperatively,SEP was detected in two of them.Of the rest 97 patients,an abnormal SEP appeared at surgery in 10 patients,and manifested different degrees of neurologic symptoms after surgery.False positive was noted in five cases,all of them showed preoperative comparatively severe symptoms of nervous system,low wave amplitude,and diffusion of waveform;false negative was recorded in two cases,appearing as postoperative stiff activities of the limbs,which were recovered in 24 hours.Conclusion Application of SEP,in posterior approach for cervical and thoracic IST resection,can immediately and reliably reflect the functional status of spinal cord.