Fujiki Minoru, Furukawa Yoshie, Kamida Tohru, Anan Mitsuhiro, Inoue Ryo, Abe Tatsuya, Kobayashi Hidenori
Department of Neurosurgery, School of Medicine, Oita University, Oita, Japan.
J Neurosurg. 2006 Jan;104(1):85-92. doi: 10.3171/jns.2006.104.1.85.
The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function.
Muscle and spinal MEPs were simultaneously recorded during surgery in 80 patients harboring brain tumors. Each case was assigned to one of four groups according to final changes in the MEPs: (1) Group A, in which there was an increased amplitude in the muscle MEP with an increased 13 wave amplitude (12 cases); (2) Group B, in which there was no significant change in the MEP (43 cases); (3) Group C, in which there was a decreased muscle MEP amplitude (< 35% of the control) with a decreased I wave amplitude but an unchanged D wave (15 cases); or (4) Group D, in which there was an absent muscle MEP with a decreased D wave amplitude (10 cases). In patients in Group A, the increase in the amplitude of the muscle MEP (range of increase 128-280%, mean increase 188.75 +/- 48.79%) was well correlated with the increase in the 13 wave in corticospinal MEPs. Most of these patterns were observed in patients harboring meningiomas (10 [83.3%] of 12 cases). Patients in Group B displayed no changes in muscle and corticospinal MEPs and no signs of postoperative neurological deterioration. Patients in Group C showed a substantial decrease in the amplitude of the muscle MEP (range of decrease 5.3-34.8% based on the control waveform, mean change 21.81 +/- 10.93%) without deterioration in the corticospinal D wave, and exhibited severe immediate postoperative motor dysfunction. This indicates dysfunction of the cortical gray matter, including the motor cortices, which are supposed to generate I waves. Patients in Group D exhibited decreases in the corticospinal D wave (range of decrease 21.5-55%, mean decrease 39.75 +/- 11.45%) and an immediate cessation of the muscle MEP as well as severe permanent motor paresis.
These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).
本研究的目的是比较从肌肉记录的运动诱发电位（肌肉运动诱发电位或皮质肌肉运动诱发电位）与从颈段硬膜外间隙记录的皮质脊髓运动诱发电位（脊髓运动诱发电位或皮质脊髓运动诱发电位），以评估它们在运动功能术中监测的有效性。
在80例患有脑肿瘤的患者手术过程中同时记录肌肉和脊髓运动诱发电位。根据运动诱发电位的最终变化，将每个病例分为四组之一：（1）A组，肌肉运动诱发电位幅度增加且13波幅度增加（12例）；（2）B组，运动诱发电位无显著变化（43例）；（3）C组，肌肉运动诱发电位幅度降低（<对照的35%）且I波幅度降低但D波不变（15例）；或（4）D组，肌肉运动诱发电位消失且D波幅度降低（10例）。在A组患者中，肌肉运动诱发电位幅度的增加（增加范围为128 - 280%，平均增加188.75 +/- 48.79%）与皮质脊髓运动诱发电位中13波的增加密切相关。这些模式大多在患有脑膜瘤的患者中观察到（12例中的10例[83.3%]）。B组患者的肌肉和皮质脊髓运动诱发电位无变化，且无术后神经功能恶化的迹象。C组患者的肌肉运动诱发电位幅度大幅降低（基于对照波形的降低范围为5.3 - 34.8%，平均变化21.81 +/- 10.93%），而皮质脊髓D波无恶化，且术后立即出现严重的运动功能障碍。这表明包括运动皮质在内的皮质灰质功能障碍，运动皮质本应产生I波。D组患者的皮质脊髓D波降低（降低范围为21.5 - 55%，平均降低39.75 +/- 11.45%），肌肉运动诱发电位立即停止，且出现严重的永久性运动麻痹。
这些结果表明，在手术过程中，监测皮质肌肉运动诱发电位（与I波相关）比监测皮质脊髓运动诱发电位（D波）是检测即时运动皮质损伤更为敏感的方法。
