ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtractio...ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtraction paradigm or alternating polarity paradigm.Three kinds of FDA approved cochlear implants support ECAP testing.This article is to summarize the clinical application of ECAP lest.ECAP test after insertion of electrode during implant operation has been widely used during cochlear implant surgery.In recent years.ECAP thresholds are also used to estimate the T levels and C levels helping programming.However,correlation between ECAP thresholds and psychophysical thresholds is affected by many factors.So far,ECAPs cannot yet be a good indicator of post-operative hearing and speech performance.展开更多
Background Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting from surgical manipulation. To improve the accuracy and sensitivity of intraoperative neuromonitoring, combin...Background Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting from surgical manipulation. To improve the accuracy and sensitivity of intraoperative neuromonitoring, combined monitoring of transcranial electrical stimulation motor evoked potentials （TES-MEPs）, somatosensory evoked potentials （SSEPs） and brainstem auditory evoked potentials （BAEPs） was attempted in microsurgery for lesions adjacent to the brainstem and intracranial aneurysms. Methods Monitoring of combined TES-MEPs with SSEPs was attempted in 68 consecutive patients with lesions adjacent to the brainstem as well as intracranial aneurysms. Among them, 31 patients （31 operations, 28 of posterior cranial fossa tumors, 3 of posterior circulation aneurysms） were also subjected to monitoring of BAEPs. The correlation of monitoring results and clinical outcome was studied prospectively. Results Combined monitoring of evoked potentials （EPs） was done in 64 （94.1%） of the 68 patients. MEPs monitoring was impossible for 4 patients （5.9%）. No complication was observed during the combined monitoring in all the patients. In 45 （66.2%） of the 68 patients, EPs were stable, and they were neurologically intact. Motor dysfunction was detected by MEPs in 8 patients, SSEPs in 5, and BAEPs in 4, respectively. Conclusions A close relationship exists between postoperative motor function and the results of TES-MEPs monitoring TES-MEPs are superior to SSEPs and BAEPs in detecting motor dysfunction, but combined EPs serve as a safe, effective and invasive method for intraoperative monitoring of the function of the motor nervous system. Monitoring of combined EPs during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms may detect potentially hazardous maneuvers and improve the safety of subsequent procedures.展开更多
基金supported by grants from the National Basic Research Program of China(973 Program)(#2012CB967900)Science and Technology Innovation Nursery Foundation of PLA General Hospital(13KMM14)Clinical Research Supporting Foundation of PLA General Hospital(2012FC-TSYS-3056)
文摘ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtraction paradigm or alternating polarity paradigm.Three kinds of FDA approved cochlear implants support ECAP testing.This article is to summarize the clinical application of ECAP lest.ECAP test after insertion of electrode during implant operation has been widely used during cochlear implant surgery.In recent years.ECAP thresholds are also used to estimate the T levels and C levels helping programming.However,correlation between ECAP thresholds and psychophysical thresholds is affected by many factors.So far,ECAPs cannot yet be a good indicator of post-operative hearing and speech performance.
文摘Background Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting from surgical manipulation. To improve the accuracy and sensitivity of intraoperative neuromonitoring, combined monitoring of transcranial electrical stimulation motor evoked potentials （TES-MEPs）, somatosensory evoked potentials （SSEPs） and brainstem auditory evoked potentials （BAEPs） was attempted in microsurgery for lesions adjacent to the brainstem and intracranial aneurysms. Methods Monitoring of combined TES-MEPs with SSEPs was attempted in 68 consecutive patients with lesions adjacent to the brainstem as well as intracranial aneurysms. Among them, 31 patients （31 operations, 28 of posterior cranial fossa tumors, 3 of posterior circulation aneurysms） were also subjected to monitoring of BAEPs. The correlation of monitoring results and clinical outcome was studied prospectively. Results Combined monitoring of evoked potentials （EPs） was done in 64 （94.1%） of the 68 patients. MEPs monitoring was impossible for 4 patients （5.9%）. No complication was observed during the combined monitoring in all the patients. In 45 （66.2%） of the 68 patients, EPs were stable, and they were neurologically intact. Motor dysfunction was detected by MEPs in 8 patients, SSEPs in 5, and BAEPs in 4, respectively. Conclusions A close relationship exists between postoperative motor function and the results of TES-MEPs monitoring TES-MEPs are superior to SSEPs and BAEPs in detecting motor dysfunction, but combined EPs serve as a safe, effective and invasive method for intraoperative monitoring of the function of the motor nervous system. Monitoring of combined EPs during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms may detect potentially hazardous maneuvers and improve the safety of subsequent procedures.
