多模式神经电生理监测指导手术切除脊髓髓内肿瘤的临床研究

Multimodal intraoperative neurophysiologic monitoring and clinical neurologic outcomes in patients with intramedullary spine tumors

目的:探讨多模式术中神经电生理监测技术(MIOM)在脊髓髓内病变手术中预测脊髓神经功能的价值。方法:回顾性分析34例脊髓髓内病变切除术,术中应用多模式神经电生理监测技术(感觉诱发电位、肌源性运动诱发电位和肌电图)监测脊髓功能,记录患者术前、术后脊髓神经功能状态及术中电生理监测数据。结果:34例脊髓髓内肿瘤手术全切28例,大部切除6例。术中有21例达到报警标准,一过性改变14例,永久性改变7例。术后6例患者出现脊髓功能加重,超过6个月的长期随访中,其中2例神经功能得到有效恢复;MIOM远期阴性预测值为100%,阳性预测值为57.1%。结论:MIOM在脊髓髓内肿瘤术中能及时发现神经损伤,有效地保护神经功能,其信号改变对术后脊髓神经功能有预测作用。

Objective：To assess the predictive capability of multimodal intraoperative neurophysiologic monitoring（MIOM）in decompression for intramedullary spine tumors. Methods：Thirty-four cases of intramedullary spine tumors were treated with MIOM[somatosensory evoked potentials（SSEP）, motor evoked potentials（MEP）and electromyography（EMG）]. Preoperative and postoperative neurologic status and intraoperative neurophysiologic data were collected. Results：Intramedullary spinal cord tumors in 34 cases were completely removed in 28 cases, and partially in 6 cases. Twenty-one cases met inclusion criteria with 14 transient changes and 7 persistent changes. Six cases developed new neurologic deficits after surgery and 2 of them had obtained recovery in the 6-months follow-up. MIOM long-term negative predictive capability was 100% while positive predictive capability was 57.1%. Conclusion：MIOM in intramedullary spinal cord lesions can accurately locate nerve injury during operation and effectively protect the nerve functions. Signal changes in MIOM can predict postoperative spinal cord nerve function.