皮质诱发电位监测技术在脑中央区病变术中的应用

Application of intraoperative monitoring of evoked potentials in patients with central area lesions

目的探讨皮质诱发电位技术在脑中央区病变手术中监测的应用价值。方法通过影像学检查筛选15例中央回及其毗邻部位的病变患者。术中采用皮质诱发电位及皮质直接电刺激定位感觉区和运动区;在保护脑功能区功能不受损的前提下,最大限度的切除病变组织。结果皮质体感诱发电位监测15例,12例能记录到位相倒置波形或主波渐变波形;直接皮层刺激记录皮质运动诱发电位共5例,2例能引发肢体运动和/或肌电反应。术毕病变全切9例,近全切6例。术后有4例患者症状改善,10例症状无恶化,1例症状恶化;术后无新发神经功能障碍病例。结论在脑中央沟区病变手术中,诱发电位监测技术可在术中精确定位重要感觉运动功能区,有效提高手术效果,保障手术安全,减少术后神经功能缺失。

Objective To study th significance of intraoperative evoked potentials in the patients with the lesions in cerebral central area.Methods Fifteen patients with the lesions located in or adjacent to the gyri central were screened by imaging.The somatosensory evoked potentials were nonitored in 15 cases and direct cortical electrical stimulation was performed in 5cases to localize the motor and sensory areas before removal of the lesions.Under the precondition of preservation of the eloquent areas,the cerebral lesions were removed as far as possible.Results The phase inversion waveform or main wave gradient waveform of somatosensory evoked potentials was recorded in 12 cases.Two of 5cases underwent direct cortical electrical stimulation showed corresponding limb movements or electromyography responses.Of 15 lesions,9lesions were totally resected and 6lesions underwent nearly total resection.Postoperatively,the symptoms were improved in 4cases,not changed in 10 cases and deteriorated in one case.Conclusion During operation in the cerebral central area,the somatosensory evoked potentials monitoring can precisely localize the eloquent sensorimotor structures in the brain,effectively improve surgical outcomes,ensure the safety of the operation and reduce postoperative neurological deficits.