Gläsker Sven, Pechstein Ulrich, Vougioukas Vassilios I, Van Velthoven Vera
Department of Neurosurgery, Neurochirurgische Universitatsklinik, Albert-Ludwigs-University, Breisacherstrasse 64, 79106, Freiburg, Germany.
Childs Nerv Syst. 2006 Oct;22(10):1288-95. doi: 10.1007/s00381-006-0101-z. Epub 2006 May 13.
Even in the days of modern microsurgery, the removal of a brain stem lesion remains a surgical challenge. Especially when operating on children, the prognosis is directly related to the radicality of the resection; however, a radical resection is often associated with surgical morbidity. Intraoperative neuromonitoring could help to minimise the surgical morbidity, but few studies have been performed to clarify the value of this monitoring. We investigated a prospective series of 21 patients with lesions involving the brain stem for the prognostic value and benefits of neuromonitoring.
We performed intraoperative neuromonitoring of cranial nerve function by electromyography (EMG) and motor evoked potential (MEP). The results were correlated with postoperative neurological deficits.
There is a good correlation between intraoperative neurophysiological events and postoperative neurological deficits in patients with lesions of the brain stem. In general, transient, prolonged, spontaneous activity in EMG is associated with a transient paresis of the respective muscle, whereas a permanent spontaneous activity is associated with a permanent deficit. Intraoperative neuromonitoring reliably predicts postoperative neurological function in patients with tumours of the lower brain stem and fourth ventricle. This neuromonitoring guides the neurosurgeon in the operation and may decrease surgical morbidity. We recommend using monitoring of MEP and EMG of the lower cranial nerves in surgery on all patients with lesions involving the lower brain stem and fourth ventricle.
即使在现代显微外科手术时代，脑干病变的切除仍然是一项手术挑战。尤其是在对儿童进行手术时，预后与切除的彻底性直接相关；然而，根治性切除往往伴随着手术并发症。术中神经监测有助于将手术并发症降至最低，但很少有研究来阐明这种监测的价值。我们对21例累及脑干病变的患者进行了前瞻性研究，以探讨神经监测的预后价值和益处。
我们通过肌电图（EMG）和运动诱发电位（MEP）对颅神经功能进行术中神经监测。将结果与术后神经功能缺损进行关联。
脑干病变患者术中神经生理事件与术后神经功能缺损之间存在良好的相关性。一般来说，EMG中短暂、持续、自发的活动与相应肌肉的短暂麻痹相关，而持续的自发活动与永久性缺损相关。术中神经监测能够可靠地预测下脑干和第四脑室肿瘤患者的术后神经功能。这种神经监测在手术中指导神经外科医生，并且可能降低手术并发症。我们建议对所有累及下脑干和第四脑室病变的患者在手术中使用下颅神经的MEP和EMG监测。
