Sala Francesco, Meneghelli Pietro
Institute of Neurosurgery, University Hospital, Verona, Italy.
Acta Neurochir Suppl. 2019;125:369-380. doi: 10.1007/978-3-319-62515-7_53.
Craniovertebral junction (CVJ) surgery encompasses a wide spectrum of neurosurgical procedures ranging from transoral approaches for CVJ bone anomalies to surgery for intramedullary tumours. Intraoperative neurophysiological monitoring (IONM) has been increasingly used in recent years because of its ability to prevent neurological complications during surgery. In CVJ surgery the risk of neurological injuries is related first to the positioning of the patient and then to the surgical procedure. Application of IONM during the positioning of the patient permits fast recognition of impending causes of neurological injury. During surgery, continuous IONM permits real-time assessment of the functional integrity of the spinal tracts and provides useful feedback during surgical manoeuvres. The applications of IONM are mainly related to intradural procedures, but wider application of these techniques during surgery for CVJ instability and degenerative disorders has recently been described, leading also to better understanding of the pathophysiology of spinal cord injuries. In this paper we review and discuss the principal IONM techniques used during surgery around the CVJ.
颅颈交界区（CVJ）手术涵盖了广泛的神经外科手术，从针对CVJ骨异常的经口入路手术到髓内肿瘤手术。近年来，术中神经生理监测（IONM）因其能够预防手术期间的神经并发症而越来越多地被使用。在CVJ手术中，神经损伤的风险首先与患者的体位有关，其次与手术操作有关。在患者体位摆放过程中应用IONM可快速识别即将发生的神经损伤原因。手术期间，持续的IONM可实时评估脊髓束的功能完整性，并在手术操作过程中提供有用的反馈。IONM的应用主要与硬脊膜内手术有关，但最近已有文献描述了这些技术在CVJ不稳定和退行性疾病手术中的更广泛应用，这也有助于更好地理解脊髓损伤的病理生理学。在本文中，我们回顾并讨论了CVJ周围手术中使用的主要IONM技术。
