脑干听觉诱发电位在后颅窝肿瘤术中对神经功能的实时监测

Real-time monitoring for nervous function during the surgical treatment of posterior fossa tumor with brainstem auditory evoked potential

目的:研究脑干及与相应颅神经功能损伤时敏感的电生理指标,为后颅窝肿瘤手术提供精确、准确和安全的术中监测手段。方法:30例后颅窝肿瘤患者,使用同一多功能神经电生理监护仪进行术中脑干听觉诱发电位(BAEP)连续实时监护,测定手术操作对这些指标的影响。结果:后颅窝肿瘤手术及其操作可以引起BAEP的改变。手术中BAEP的I波(1.76±0.08)ms,III波(4.45±0.20)ms,V波(6.67±0.13)ms潜伏期,I～V(5.01±0.31)ms,III～V(2.40±0.14)ms,峰间潜伏期较手术开始时明显延长(t=8.216,6.816,25.087,7.343,11.585,P<0.01),V波幅(0.39±0.07)μV明显降低(t=3.565,P<0.01)。其中以BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论:BAEP的Ⅴ波潜伏期延长和波幅下降是后颅窝肿瘤术中敏感的电生理指标,对其进行监护,可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免患者手术后神经功能损伤。

AIM:To study the sensitive electrophysiological parameters on the injuries of brainstemand the responding crania l nerves,and provide the sensitive,precise and safe intraoperative monitoring way for the posterior fossa operatio ns.METHODS :Brainstem auditory evoked potentia l(BAEP)used as intraop-erative monitoring way was continuously conducted in 30patients with pos-terior fossa tumors by a multiple fun ctional neuroelectrophysiological moni-tor.The effects of operation on the p arameters were recorded.RESULTS:All the parameters changed after posterior cranial fossa opera-tions.TheⅠwave latency(1.76±0.08)ms,Ⅲwave latency(4.45±0.20)ms andⅤwave latency(6.67±0.13)ms,Ⅰ-Ⅴinterpeak latency(5.01±0.31)ms andⅢ-Ⅴinterpeak latency(2.40±0.14)ms were significantly prolonged intraoperatively(t=8.216,t=6.816,t=25.087,t=7.343,t=11.585,P<0.01),while the amplitude ofⅤwave was significantly reduced during the op eration(t =3.565,P <0.01).