Deletis Vedran, Fernández-Conejero Isabel
Laboratory for Human and Experimental Neurophysiology, School of Medicine, Split, Croatia.
Department of Intraoperative Neurophysiology, University Hospital of Bellvitge, Barcelona, Spain.
J Clin Neurol. 2016 Jul;12(3):262-73. doi: 10.3988/jcn.2016.12.3.262.
The risk of iatrogenic damage is very high in surgical interventions in or around the brainstem. However, surgical techniques and intraoperative neuromonitoring (ION) have evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. We present a critical review of the methodologies available for intraoperative monitoring and mapping of the brainstem. There are three main groups of techniques that can be used to assess the functional integrity of the brainstem: 1) mapping, which provides rapid anatomical identification of neural structures using electrical stimulation with a hand-held probe, 2) monitoring, which provides real-time information about the functional integrity of the nervous tissue, and 3) techniques involving the examination of brainstem reflexes in the operating room, which allows for the evaluation of the reflex responses that are known to be crucial for most brainstem functions. These include the blink reflex, which is already in use, and other brainstem reflexes that are being explored, such as the masseter H-reflex. This is still under development but is likely to have important functional consequences. Today an abundant armory of ION methods is available for the monitoring and mapping of the functional integrity of the brainstem during surgery. ION methods are essential in surgery either in or around the brainstem; they facilitate the removal of lesions and contribute to notable improvements in the functional outcomes of patients.
在脑干及其周围进行手术干预时，医源性损伤的风险非常高。然而，手术技术和术中神经监测（ION）已经有了充分的发展，足以提高许多患者获得成功功能预后的可能性。我们对可用于脑干术中监测和定位的方法进行了批判性综述。有三类主要技术可用于评估脑干的功能完整性：1）定位，使用手持探头通过电刺激快速对神经结构进行解剖学识别；2）监测，提供有关神经组织功能完整性的实时信息；3）在手术室检查脑干反射的技术，可评估已知对大多数脑干功能至关重要的反射反应。这些反射包括已经在使用的眨眼反射，以及正在探索的其他脑干反射，如咬肌H反射。该反射仍在开发中，但可能会产生重要的功能影响。如今，有大量的ION方法可用于手术期间监测和定位脑干的功能完整性。ION方法在脑干及其周围的手术中至关重要；它们有助于切除病变，并显著改善患者的功能预后。
