摘要
目的分析皮质和皮质下电刺激阈值在定位运动通路和指导功能区胶质瘤手术中的应用价值，确定最小安全阈值。方法北京天坛医院神经外科2015至2017年应用该技术结合术中超声指导功能区胶质瘤手术57例。患者采用全静脉麻醉以减少对电生理的影响，在肿瘤切除过程中，根据刺激阈值的大小判断锥体束距离并指导肿瘤切除，根据运动功能评分评价患者运动功能，应用ROC曲线确定最小安全阈值。结果全切除32（56．1％）例，次全切除22（38．6％）例，部分切除3（5．3％）例。术前9例患者存在肢体活动障碍，与术前相比，19例在术后第1天出现肢体运动评分下降，其中5例在术后第7天恢复到术前水平，7例在术后3个月时恢复的术前水平，另外7例在术后3个月时仍未能恢复到术前水平。术中痉挛的发生率为1．8％（1／57），未发现与监测相关的其他不良反应。ROC曲线分析显示皮质下单极阈值5．7mA可作为最小安全阈值，以减少对运动功能的损伤。单因素分析术后肢体运动评分下降的临床相关因素包括：（1）最小皮质下单极阈值≤5．7mA；（2）经颅MEP下降。结论皮质和皮质下电刺激阈值对定位运动通路和指导功能区胶质瘤手术具有重要的应用价值，5．7mA可作为最小安全阈值定位肿瘤的功能边界。
Objective This study aimed to analyze the application of cortical and subcortical stimulation threshold in identifying the motor pathway and guiding the resection of gliomas in the functional area, and to illustrate the minimal safe threshold by ROC method. Methods Fifty-seven patients with gliomas in the functional areas were enrolled in the study at Beijing Tiantan Hospital from 2015 to 2017. Anesthesia was maintained intravenously with propofol 10% and remifentanil. Throughout the resection process, cortical or subcortical stimulation threshold was determined along tumor border using monopolar or bipolar electrodes. The motor pathway was identified and protected from resection according to the stimulation threshold and transeranial MEPs. Minimal threshold in each case was recorded. Results Total resection was achieved in 32 cases （56. 1% ）, sub-total resection in 22 cases （38.6%）, and partial resection in 3 cases （ 5.3% ） . Pre-operative motor disability was found in 9 cases. Compared with pre- operative motor scores, 19 exhibited impaired motor functions on day 1 after surgery, 5 had quick recovery by day 7 after surgery, and 7 had late recovery by 3 months after surgery. At 3 months, 7 still had impaired motor function. The frequency of intraoperative seizure was 1.8% （1/57）. No other side effect was found during electronic monitoring in the operation. The ROC curve revealed that the minimal safe monopolar subeortical threshold was 5.70 mA for strength deterioration on day 1 and day 7 after surgery. Univariate analysis revealed that decreased transcranial MEPs and minimal subcortical threshold ≤ 5.7 mA were correlated with postoperative strength deterioration. Conclusions Cortical and subcortical stimulationthreshold has its merit in identifying the motor pathway and guiding the resection for tumors within the functional areas. 5.7 mA can be used as the minimal safe threshold to protect the motor pathway from injury.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第9期653-657,共5页
National Medical Journal of China
基金
国家自然科学基金（81401381,81571632,81771309）
首都卫生发展科研专项基金（2014-2-2042）
关键词
胶质瘤
手术
功能区
电刺激
致残率
Gliomas
Surgery
Functional area
Electric stimulation
Disability
