摘要
目的:探讨神经电生理监测对脑干手术的指导意义,总结实施体会和改进方向。方法:回顾分析了既往2年内,在电生理监测下完成手术的48例脑干肿瘤病例资料。在总结手术疗效的同时,就影像资料对临床判断的指导作用,手术指征的把握,电生理指标的选择和意义等进行了讨论。结果:运用听觉脑干诱发电位、体感诱发电位、运动诱发电位等手段,为手术提供了强有力的支持。48例患者中,27例全切,15例大部切除,6例部分切除;术后无1例昏迷,一例因脑室炎死亡;神经机能较术前相仿或改善者31例,症候加重或出现新的废损17例(治疗随访,12例明显恢复,达到术前神经机能水平)。结论:在手术入路日趋成熟的今天,多参数神经电生理监测对于提高手术疗效、减少功能废损,具有重要意义。它为术中选择切入的安全区或探知神经通路的完整性提供了有力支撑,但对于特定神经机能评判仍存在不确定性,需要进一步研究。
Objective： To discuss the significance of intraoperative neurophysiological monitoring （IOM） during brain stem surgery,and summarize the experience and shortcomings of IOM. Methods：Forty-eight cases within 2 years were analyzed retrospectively,focusing on the surgical results and monitoring techniques. Resuhs：IOM provided consolidated support for the brain stem surgery- total resection was achieved in 27 cases, subtotal resection in 15 cases and partial resection in 6 cases;there was no deterioration of mental status after surgery,and only one case of death due to ventriculitis. The neurological status remained stable or improved in 31 cases, while 17 cases showed exacerbation （among which 12 cases achieved significant improvement during follow-up）. Conclusion：Although the surgical approaches presented no problem anymore, IOM established itself as one paths by which modern neurosurgery could improve surgical results while minimizing morbidity. IOM could provide the mapping of neuronal structures and test the integrity of neuronal pathways, but uncertainty still remained which needs further investigation.
出处
《华西医学》
CAS
2009年第1期4-6,共3页
West China Medical Journal
