神经电生理监测在椎管内肿瘤患者术中应用的价值

Use of intraoperative electrophysiological monitoring in surgery for intraspinal tumors

中文关键词:  椎管内肿瘤  手术  神经电生理监测

英文关键词:Intraspinal tumors  Operation  Neurophysiological monitoring

中文摘要:

  【摘要】 目的：探讨神经电生理监测在椎管内肿瘤患者术中应用的价值。方法：2000年10月~2010年10月手术治疗椎管内肿瘤患者358例，均为硬膜内肿瘤，其中髓外硬膜下肿瘤234例，髓内肿瘤124例。术前均行肿瘤累及相应节段的肌电图（EMG）及体感诱发电位（SEP）检测。术中监测神经电生理变化，用SEP监测脊髓功能，EMG确定肿瘤切除范围。均在术中神经电生理监测下显微镜下操作完成手术。结果：358例患者术中自发性EMG监测无异常；124例髓内肿瘤患者术中应用激发性EMG确立“安全地带”，判定病变切除范围，避免了“危险操作”。术中监测SEP异常36例，其中29例SEP波幅降低20%～30%时，监测人员提醒术者寻找原因，减少刺激、牵拉及压迫后10~20min，SEP波形逐渐恢复至术前水平；7例髓内病变患者SEP波幅降低超过50%，暂停手术操作后30min左右，SEP有所恢复，继续完成手术。358例患者均在神经电生理监测下显微镜下操作切除病变，肿瘤全切292例，其中硬膜内髓外肿瘤234例（100%）显微镜下全切，术中无SEP异常。髓内肿瘤124例，显微镜下全切58例（46.8%），次全或大部分切除66例（53.2%）；7例术中SEP波幅降低超过50%的患者术后神经症状加重，其中6例用甲基强的松龙及神经营养药等治疗7~10d神经症状恢复至术前水平，1例改善不明显。结论：术中应用神经电生理监测指导椎管内肿瘤的切除，可提高肿瘤切除率，避免副损伤，提高肿瘤切除的安全性。

英文摘要:

  【Abstract】 Objectives: To investigate the use of intraoperative electrophysiological monitoring in surgery for intraspinal tumors. Methods: 358 cases suffering from intraspinal tumors treated surgically from October 2000 to October 2010 were reviewed retrospectively. There were 234 cases of extramedullary intradural tumor and 124 cases of intramedullary tumor. All patients underwent electromyography(EMG) and somatosensory evoked potential(SEP) test of involved segments, which were used for comparement. Neural electricity physician was responsible for electrical monitoring during the operation, and SEP was used for monitoring spinal cord function, which was used to determine the range of defect resection. All tumors were removed microscopically under intraoperative neurophysiological monitoring. Results: Spontaneous EMG of 358 cases in intraoperative monitoring showed no abnormalities. EMG was used to determine the safe zone as well as the range of defect resection in 124 cases with intramedullary tumor. SEP showed abnormal in 36 cases during operation, of these, 29 cases had SEP amplitude decreasing of 20%-30%, which was detected by physician. After corresponsive intervention, SEP returned to preoperative levels 10-20min later. The SEP amplitude of 7 cases with intramedullary tumor decreased over 50%. After ceasing operation for 30mins, SEP recovered a little, and the operation continued. 358 tumors were removed microscopically under intraoperative neurophysiological monitoring, En bloc was performed in 292 cases including 234 extramedullary intradural tumor with normal intraoperative SEP. Of 124 intramedullary tumors, 58 tumors were removed completely(46.8%), while 66 intramedullary tumors were performed partial resection(53.2%). 7 cases suffering from SEP amplitude decreasing over 50% in operation had neurofunction deteriorated, of them, 6 cases had neurofunction recovered to preoperative level after corresponsive intervention 7-10 days later, while 1 case showed no improvement. Conclusions： The intraoperative neurophysiological monitoring can be used to guide the resection of tumor safely and effectively.