Lee Jung Jae, Kim Young Il, Hong Jae Taek, Sung Jae Hoon, Lee Sang Won, Yang Seung Ho
Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
J Korean Neurosurg Soc. 2014 Aug;56(2):98-102. doi: 10.3340/jkns.2014.56.2.98. Epub 2014 Aug 31.
The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery.
Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status.
MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection.
MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.
本研究旨在评估运动诱发电位（MEP）监测在幕上肿瘤手术中的可行性及临床疗效。
2010年至2012年间，为预防术后运动功能恶化，对84例幕上脑肿瘤患者（男45例，女39例；年龄范围24 - 80岁；中位年龄58岁）进行经颅刺激后的MEP记录。将MEP监测结果与术前运动状态相比的术后运动结果进行关联分析。
77例患者（91.7%）手术期间MEP记录的波幅稳定（波幅降低<50%）。77例MEP波幅稳定的患者中，66例未出现术后运动功能缺损。然而，11例患者出现术后轻瘫。假阴性结果与切除周边区域的水肿及肿瘤床术后出血有关。7例患者（8.3%）MEP波幅降低>50%。然而，4例患者在手术期间进行预防性处理后术后未出现功能缺损。3例患者出现永久性轻瘫，可能与肿瘤切除过程中的血管损伤有关。
幕上肿瘤手术期间MEP监测是可行且安全的。然而，部分患者可能出现与术后事件相关的MEP假阴性结果。为实现成功监测，外科医生、麻醉医生及经验丰富的技术人员之间的协作必不可少。
