神经电生理监测技术在脊髓髓内肿瘤切除术中的应用

Application of neurophysiological monitoring in intramedullary spinal cord tumor resection

目的探讨神经电生理技术联合监测对预防脊髓髓内肿瘤切除术中脊髓神经功能损伤的意义。方法回顾性分析26例脊髓髓内肿瘤的病例资料,均行手术切除治疗,术中应用体感诱发电位(SEP-P40)和运动诱发电位(MEP-ABP)监测。结果术后2周随访脊髓神经功能JOA评分改善10例,不变13例,下降3例。JOA评分改善者,手术前后SEP-P40潜伏期、波幅改变及MEP-ABP潜伏期改变均具有统计学意义(P<0.01)。JOA评分不变者,手术前后SEP-P40潜伏期、波幅改变及MEP-ABP潜伏期改变均无统计学意义(P>0.05)。结论脊髓髓内肿瘤切除术中使用神经电生理联合监测能及时反映神经功能变化,术中电生理指标变化与病人术后神经功能改变一致。联合监测可提高术中操作的安全性,能避免或减少并发症。

Objective To evaluate the significance of neurophysiological monitoring in the prevention of spinal cord injury in the context of intramedullary spinal cord tumor resection. Methods The clinical data of 26 patients with intramedullary spinal cord tumors were analyzed retrospectively. All the patients received surgical resection, and somatosensory evoked potential（SEP-P40） and motion evoked potential（MEP-ABP） monitoring were applied in the process of the surgery. Results The follow-up after 2 weeks of the surgery showed the JOA score of neurological function was improved in 10 cases, unchanged in 13 and dropped in 3. The difference in incubation period and amplitude of SEP-P40 and incubation period of MEP-ABP between pre- and post-operation was statistically significant（P 〈0.01） in the patients with JOA score improved. The pre- and post-operative incubation period and amplitude of SEP-P40 and incubation period of MEP-ABP showed no statistical difference（ P〉 0. 05） in those patients without change of JOA score.Conclusions The application of joint neurophysiological monitoring in intramedullary spinal cord tumor resection can reflect the variation of neural function in time. The change of neurophysiological index during the surgery is consistent with the change of neural function in postoperative patients. To improve the safety of intraoperative operation by joint neurophysiological monitoring can avoid or reduce the complications.