Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata City, Japan.
J Neurosurg. 2012 Mar;116(3):605-10. doi: 10.3171/2011.10.JNS111343. Epub 2011 Dec 9.
The purpose of this study was to determine whether monitoring of pharyngeal motor evoked potentials (PhMEPs) elicited by transcranial electrical stimulation during skull base tumor surgery might be useful for predicting postoperative swallowing deterioration.
The authors analyzed PhMEPs in 21 patients during 22 surgical procedures for the treatment of skull base tumors. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli (220-550 V). Pharyngeal MEPs were recorded from the posterior wall of the pharynx through a modified endotracheal tube. The correlation between the final/baseline PhMEP ratio and postoperative swallowing function was examined.
Postoperative swallowing function was significantly (p < 0.05), although not strongly (r = -0.47), correlated with the final/baseline PhMEP ratio. A PhMEP ratio < 50% was recorded during 4 of 22 procedures; in all 4 of these cases, the patients experienced postoperative deterioration of swallowing function. After 18 procedures, the PhMEP ratios remained > 50%; nevertheless, after 4 (22.2%) of these 18 procedures, patients showed deterioration of swallowing function.
Intraoperative PhMEP monitoring can be useful for predicting swallowing deterioration following skull base surgery, especially in patients with swallowing disturbances that are mainly due to reduction in the motor functions of the pharyngeal muscles.
本研究旨在确定经颅电刺激诱发的咽肌运动诱发电位（PhMEPs）监测在颅底肿瘤手术中是否有助于预测术后吞咽恶化。
作者分析了 21 例颅底肿瘤患者 22 例手术期间的 PhMEPs。C3 或 C4 和 Cz 处的螺旋电极用于传递最大刺激（220-550V）。通过改良的气管内管从咽后壁记录咽肌 MEPs。检查最终/基线 PhMEP 比值与术后吞咽功能之间的相关性。
尽管相关性不强（r = -0.47），但术后吞咽功能与最终/基线 PhMEP 比值显著相关（p < 0.05）。在 22 次手术中有 4 次记录到 PhMEP 比值 < 50%；在这 4 例患者中，均发生术后吞咽功能恶化。在 18 次手术中，PhMEP 比值保持>50%；然而，在这 18 次手术中的 4 次（22.2%）中，患者出现吞咽功能恶化。
术中 PhMEP 监测对于预测颅底手术后吞咽恶化可能是有用的，特别是在吞咽障碍主要是由于咽肌运动功能下降的患者中。
