Visser Jetze, Verra Wiebe C, Kuijlen Jos M, Horsting Philip P, Journée Henricus L
*Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands; and †Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands.
J Clin Neurophysiol. 2014 Dec;31(6):568-74. doi: 10.1097/WNP.0000000000000099.
PURPOSE: This study aimed to illustrate the recovery of transcranial electrical stimulation motor evoked potentials during surgical decompression of the spinal cord in patients with impaired motor function preoperatively. Specific attention was paid to the duration of neurologic symptoms before surgery and the postoperative clinical recovery. METHODS: A case series of eight patients was selected from a cohort of 74 patients that underwent spine surgery. The selected patients initially had low or absent transcranial electrical stimulation motor evoked potentials followed by a significant increase after surgical decompression of the spinal cord. RESULTS: A significant intraoperative increase in amplitude of motor evoked potentials was detected after decompression of the spinal cord or cauda equina in patients suffering from spinal canal stenosis (n = 2), extradural meningioma (n = 3), or a herniated nucleus polposus (n = 3). This was related to an enhanced neurologic outcome only if patients (n = 6) had a short onset (less than ½ year) of neurologic impairment before surgery. CONCLUSIONS: In patients with a short onset of neurologic impairment because of compression of the spinal cord or caudal fibers, an intraoperative recovery of transcranial electrical stimulation motor evoked potentials can indicate an improvement of motor function postoperatively. Therefore, transcranial electrical stimulation motor evoked potentials can be considered as a useful tool to the surgeon to monitor the quality of decompression of the spinal cord.
目的:本研究旨在阐明术前运动功能受损患者在脊髓手术减压过程中经颅电刺激运动诱发电位的恢复情况。特别关注术前神经症状的持续时间以及术后的临床恢复情况。 方法:从74例行脊柱手术的患者队列中选取了8例患者作为病例系列。所选患者最初经颅电刺激运动诱发电位较低或无,而在脊髓手术减压后显著增加。 结果:在患有椎管狭窄(n = 2)、硬膜外脑膜瘤(n = 3)或腰椎间盘突出症(n = 3)的患者中,脊髓或马尾减压后检测到运动诱发电位幅度在术中显著增加。仅当患者(n = 6)术前神经功能损害的发病时间较短(少于半年)时,这才与神经功能改善相关。 结论:对于因脊髓或尾神经纤维受压导致神经功能损害发病时间较短的患者,术中经颅电刺激运动诱发电位的恢复可表明术后运动功能的改善。因此,经颅电刺激运动诱发电位可被视为外科医生监测脊髓减压质量的有用工具。
J Clin Neurophysiol. 2014-12
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