全身麻醉下视觉诱发电位在垂体腺瘤切除术中的应用价值

The application value of visual evoked potential under general anesthesia in pituitary adenoma resection

目的探讨全身麻醉下视觉诱发电位(VEP)在垂体腺瘤切除术中的应用价值。方法回顾性分析2019年2月至2021年2月首都医科大学附属北京天坛医院神经外科连续收治的术中行VEP监测的61例脊髓脊柱肿瘤患者和10例垂体腺瘤患者的临床资料。61例脊髓脊柱肿瘤患者术中VEP的记录导联包括O1-FZ、OZ-FZ及O2-FZ,其中31例采用静吸复合麻醉(复合麻醉组),另30例采用全静脉麻醉(静脉麻醉组),通过比较不同导联和不同麻醉方式对VEP的影响,确定术中VEP的主要观察指标。之后将其应用于同期首都医科大学附属北京天坛医院神经外科采用经鼻神经内镜肿瘤切除术的10例合并视觉功能损伤的垂体腺瘤患者,术后7 d对其行视力、视野检查,以判断术中观察指标与术后视觉功能的相关性。结果61例脊髓脊柱肿瘤患者术中监测的N145-P100峰值差(N2波幅)在3个导联之间的差异无统计学意义(P>0.05),但在OZ-FZ导联上N75-P100峰值差(N1波幅)高于其他2个导联(P<0.05)。在OZ-FZ导联上,采用不同麻醉方式的两组患者N1和N2波幅的差异均无统计学意义(P>0.05)。10例垂体腺瘤患者术中在OZ-FZ导联上均可监测到VEP,引出率为100%;其中6例N1波幅值均较基线升高,术后视力和视野均较术前改善;3例的N1波幅值发生先降低后升高的改变,其中2例术后视力和视野较术前无明显改变,1例较术前改善;1例N1波幅值较基线无明显变化,术后视力和视野无明显改变。结论初步发现垂体腺瘤患者术中通过在VEP的OZ-FZ导联上观察N1波幅的变化可预估其术后视觉功能的改变情况。

Objective To investigate the application value of visual evoked potential(VEP)in pituitary adenoma resection under general anesthesia.Methods A retrospective analysis was performed on 61 spinal cord and spine tumor patients and 10 pituitary adenoma patients who underwent VEP monitoring who were consecutively admitted to Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from February 2019 to February 2021.Recording leads of intraoperative VEP included O1-FZ,OZ-FZ,and O2-FZ.Among them,31 received combined intravenous and inhalation anesthesia(composite group)and 30 received total intravenous anesthesia(intravenous group).By comparing the effects of different montages and different anesthesia methods on VEP,we determined the main observation indicators of VEP.Later,the VEP was applied to 10 cases of pituitary adenoma patients with visual impairment who were treated by surgical resection at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University.Visual acuity and visual field were tested 7 days after operation to determine the correlation between intraoperative observation indexes and postoperative visual function.Results In 61 spinal cord and spine tumor patients,the monitor values of VEP at OZ-FZ lead during the operation were higher than those at other two leads(O1-FZ and O2-FZ)when comparing the peak difference between N75-P100(N1 amplitude)(P<0.05)while similar in the peak difference between N145-P100(N2 amplitude)(P>0.05).At the OZ-FZ montage,there was no significant difference in the amplitude of N1 or N2 between the two groups of patients undergoing different methods of anesthesia(P>0.05).VEP could be applied during operation in all 10 patients with pituitary adenoma,and the induction rate was 100%.Among them,the N1 wave amplitudes was higher than baseline in 6 cases,and their visual acuity and visual field were improved post operation compared with preoperative conditions.In 3 cases,the N1 wave amplitudes was first reduced and then recovered,of which 2 cases had no significant changes in visual acuity or visual field after operation,and 1 case improved compared to preoperative conditions.In 1 case,N1 wave amplitude did not change significantly compared with baseline,and no obvious change was observed in vision or visual field after surgery.Conclusion It is preliminarily found that postoperative change of visual function in patients with sellar tumors can be predicted by observing the changes in the amplitude of N1 at the OZ-FZ montage.