在幕上病变手术中，经颅运动诱发电位的阈值标准与振幅标准比较。
A comparison between threshold criterion and amplitude criterion in transcranial motor evoked potentials during surgery for supratentorial lesions.
机构信息
1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and.
2Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
出版信息
J Neurosurg. 2018 Sep 7;131(3):740-749. doi: 10.3171/2018.4.JNS172468. Print 2019 Sep 1.
OBJECTIVE
The aim of this study was to compare sensitivity and specificity between the novel threshold and amplitude criteria for motor evoked potentials (MEPs) monitoring after transcranial electrical stimulation (TES) during surgery for supratentorial lesions in the same patient cohort.
METHODS
One hundred twenty-six patients were included. All procedures were performed under general anesthesia. Craniotomies did not expose motor cortex, so that direct mapping was less suitable. After TES, MEPs were recorded bilaterally from abductor pollicis brevis (APB), from orbicularis oris (OO), and/or from tibialis anterior (TA). The percentage increase in the threshold level was assessed and considered significant if it exceeded by more than 20% on the affected side the percentage increase on the unaffected side. Amplitude on the affected side was measured with a stimulus intensity of 150% of the threshold level set for each muscle.
RESULTS
Eighteen of 126 patients showed a significant change in the threshold level as well as an amplitude reduction of more than 50% in MEPs recorded from APB, and 15 of the patients had postoperative deterioration of motor function of the arm (temporary in 8 cases and permanent in 7 [true-positive and false-negative results]). Recording from TA was performed in 66 patients; 4 developed postoperative deterioration of motor function of the leg (temporary in 3 cases and permanent in 1), and showed a significant change in the threshold level, and an amplitude reduction of more than 50% occurred in 1 patient. An amplitude reduction of more than 50% occurred in another 10 patients, without a significant change in the threshold level or postoperative deterioration. Recording from OO was performed in 61 patients; 3 developed postoperative deterioration of motor function of facial muscles (temporary in 2 cases and permanent in 1) and had a significant change in the threshold level, and 2 of the patients had an amplitude reduction of more than 50%. Another 6 patients had an amplitude reduction of more than 50% but no significant change in the threshold level or postoperative deterioration.Sensitivity of the threshold criterion was 100% when MEPs were recorded from APB, OO, or TA, and its specificity was 97%, 100%, and 100%, respectively. Sensitivity of the amplitude criterion was 100%, 67%, and 25%, with a specificity of 97%, 90%, and 84%, respectively.
CONCLUSIONS
The threshold criterion was comparable to the amplitude criterion with a stimulus intensity set at 150% of the threshold level regarding sensitivity and specificity when recording MEPs from APB, and superior to it when recording from TA or OO.
目的
本研究旨在比较经颅电刺激（TES）后监测运动诱发电位（MEP）的新型阈值和振幅标准在同一患者队列中用于幕上病变手术的敏感性和特异性。
方法
共纳入 126 例患者。所有手术均在全身麻醉下进行。开颅术未暴露运动皮质，因此直接映射不太合适。TES 后，双侧从拇短展肌（APB）、口轮匝肌（OO）和/或胫骨前肌（TA）记录 MEP。如果受影响侧的百分比增加超过未受影响侧的 20%，则评估并认为阈值水平的百分比增加具有显著性。受影响侧的振幅用设定为每个肌肉的阈值水平的 150%的刺激强度进行测量。
结果
126 例患者中有 18 例患者的 APB 记录的 MEP 阈值水平出现显著变化，且振幅降低超过 50%，其中 15 例患者术后手臂运动功能恶化（暂时性 8 例，永久性 7 例[真阳性和假阴性结果]）。在 66 例患者中进行了 TA 的记录；4 例患者出现腿部运动功能恶化（暂时性 3 例，永久性 1 例），并出现阈值水平的显著变化，且 1 例患者的振幅降低超过 50%。另外 10 例患者的振幅降低超过 50%，但阈值水平无显著变化或术后无恶化。在 61 例患者中进行了 OO 的记录；3 例患者出现面部肌肉运动功能恶化（暂时性 2 例，永久性 1 例），且阈值水平出现显著变化，其中 2 例患者的振幅降低超过 50%。另外 6 例患者的振幅降低超过 50%，但阈值水平无显著变化或术后无恶化。当从 APB、OO 或 TA 记录 MEP 时，阈值标准的敏感性为 100%，其特异性分别为 97%、100%和 100%。当刺激强度设定为阈值水平的 150%时，振幅标准的敏感性为 100%、67%和 25%，特异性分别为 97%、90%和 84%。
结论
当从 APB 记录 MEP 时，阈值标准与刺激强度设定为阈值水平的 150%的振幅标准在敏感性和特异性方面相当，而从 TA 或 OO 记录时则优于该标准。
Zotero 插件