术中神经电生理监测联合B超在脑功能区病变手术中的应用

Application of neurophysiological monitoring combined with intraoperative ultrasound during surgery of lesions at central regions

目的探讨在脑功能区病变手术中联合应用神经电生理监测和B超的价值。方法对22例大脑功能区及其附近的皮质下占位病变,采用术中实时超声定位病变的解剖边界,在全凭静脉麻醉下结合体感诱发电位波形翻转(SEP-PR)、直接皮层电刺激(DCES)确定功能区边界,根据病变与功能区的关系切除病变。结果 22例病变均成功实施了术中超声定位和神经电生理监测,全组脑功能区皮层结构得到保护,10例因超声的实时监测而避免或减少了病变的残留。术后Karnofsky生活状态量表(KPS)评分较术前提高。结论神经电生理监测和实时B超是脑功能区病变手术中安全、方便、实用的辅助技术,全凭静脉麻醉下联合应用可以提高大脑功能区病变的切除率和减少术后功能障碍。

[Objective] To explore the application value of intraoperative neuroeletrophysiological and ultrasound monitoring during neurosurgical treatment for lesions at central regions. [ Method ] Under total intravenous aneasthe- sia（TIVA）, 22 lesions at central regions were resected under directions from somatosensory evoked potential phase re- versed（SEP-PR） and direct cortical electrical stimulation（DCES） for definite mutual boundaries after primarily locat- ed by intraoperative real-time ultrasound. [Results ] Intraoperative neuroeletrophysiological and ultrasound monitor- ing were successfully performed in 22 cases for protection of cortical functional areas. Residual lesion was precluded or maximally decreased in 10 cases with improved postoperative Karnofsky scale（KPS） owing to intraoperative ultra- sound. [ Conclusions ] Under TIVA, intaoperative neuroeletrophysiological and real-time ultrasound monitoring pro- vide safe, convenient and practical directions for neurosurgical treatments of lesions at central regions to increase resection rate and reduce postoperative morbidity.