神经电生理监测技术联合神经导航技术在大脑中央区病变手术中的应用

Clinical application of neural electrophysiological monitoring combined with neuronavigation in operation on cerebral central region lesions

目的探讨神经电生理监测技术联合神经导航技术在大脑中央区病变手术治疗中的应用价值。方法对11例大脑中央区病变患者,在手术中选择性应用神经导航和神经电生理监测技术(头皮体感诱发电位、皮质体感诱发电位、头皮运动诱发电位、头皮直接皮质电刺激)定位功能区,显微操作下切除病灶。结果术中行神经导航8例(其中4例行基于锥体束成像的功能神经导航);行头皮体感诱发电位监测7例,1例波幅下降,调整操作后恢复;行皮质体感诱发电位监测8例,5例能记录到位相倒置波形或主波渐变波形;行头皮运动诱发电位监测2例,直接皮层刺激共4例,1例能引发肢体运动和(或)肌电反应。病变全部切除8例,近全切除1例,大部分切除2例。术后有8例患者症状改善,3例症状无恶化,所有患者均未出现新发神经功能障碍。结论在大脑中央区病变手术中,神经电生理监测技术联合神经导航技术可精确定位病灶和重要感觉运动功能区,能有效提高手术效果,保障手术安全,减少术后神经功能缺失。

Objective To evaluate the clinical application of combination of evoked potential monitoring and neuro-navigation in operations on lesions in the cerebral central region Methods Eleven patients with central region lesions underwent microscopic resection. During the operation eloquent cortex was located by selective application of neuronavigation and neurophysiological monitoring techniques, including scalp somatosensory evoked potentials, cortical somatosensory evoked potentials and direct cortical electrical stimulation. Results Neuronavigation was performed intraoperatively in 8 patients, 4 of whom received functional neuronavigation to il ustrate pyramidal tracts. Moreover, scalp somatosensory evoked potentials were monitored in 7 patients; decreased potentials were observed in 1 case, but the patient was ful y recovered after proper adjustment of surgical manipulation. Cortical somatosensory evoked potentials were monitored in 8 cases, and reversal potentials or similar waves were detected in 5 of them. Scalp motor evoked potentials and direct cortical electrical stimulation were performed in 2 and 4 patients respectively, 1 of whom showed corresponding limb movements and （or） EMG responses. Among 11 patients, 7 got total resection, 1 got subtotal resection and 3 partial resection. Postoperatively, no patients showed deteriorated or newly developed symptoms; the symptoms were improved successful y in 8 patients. Conclusion Combined application of evoked potential monitoring and neuronavigation in operations on lesions of the central region, is critical to precisely distinguish lesions and eloquent sensorimotor structures in the brain, and therefore it can improve surgical effects, and reduce postoperative neurological deficits.