Morota Nobuhito, Ihara Satoshi, Deletis Vedran
Department of Neurosurgery, National Children's Medical Center, National Center for Child Health and Development, Tokyo, Japan.
Childs Nerv Syst. 2010 Apr;26(4):513-21. doi: 10.1007/s00381-009-1080-7. Epub 2010 Feb 9.
New advancements of intraoperative neurophysiology for surgery in and around the brainstem have been described. NEUROPHYSIOLOGICAL TECHNIQUES: Brainstem mapping (BSM) is applied to locate cranial nerves and their motor nuclei (CMN) on the floor of the fourth ventricle. Corticobulbar tract (CBT) motor-evoked potential (MEP) monitoring is used to achieve on-line monitoring of the cranial motor nerves' functional integrity.
Each of these procedures bears a specific role: BSM can help avoid direct damage to CMNs on the fourth ventricular floor; CBT-MEP can provide simultaneous feedback on the functional integrity of the CBT and CMN during surgery, eventually leading to "tailored" modifications of the surgical procedure, based upon neurophysiological responses.
CBT-MEP monitoring has less restriction in terms of clinical indications, but a combination of both procedures is essential for functional preservation of CMNs during surgery in and around the brainstem.
术中神经生理学在脑干及其周围手术中的新进展已有描述。
脑干图谱（BSM）用于在第四脑室底部定位颅神经及其运动核（CMN）。皮质延髓束（CBT）运动诱发电位（MEP）监测用于对颅运动神经的功能完整性进行在线监测。
这些操作各有特定作用：BSM有助于避免直接损伤第四脑室底部的CMN；CBT-MEP可在手术期间提供关于CBT和CMN功能完整性的同步反馈，最终根据神经生理反应对手术过程进行“定制化”调整。
CBT-MEP监测在临床适应症方面限制较少，但在脑干及其周围手术中，两种操作相结合对于CMN的功能保护至关重要。
