Stankovic P, Wittlinger J, Georgiew R, Dominas N, Hoch S, Wilhelm T
Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Germany.
Department of Otolaryngology, Head and Neck Surgery, Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany.
HNO. 2020 Aug;68(Suppl 2):86-92. doi: 10.1007/s00106-020-00824-1.
Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.
尽管术中神经监测（IONM）的历史可以追溯到19世纪，但直到最近，该方法也不过是对神经进行简单区分而已，并无进一步发展。直到连续术中神经监测（cIONM）技术的出现，才使得在外科手术过程中能够对兴奋幅度和潜伏期进行不间断分析，如今这一技术已被整合到几乎所有商用神经监测设备的软件中。cIONM的目标是实时监测神经状态，以便识别并预防即将发生的神经损伤，并预测术后神经功能。尽管存在一些缺点，如假阳性/阴性警报、技术假象以及罕见的不良反应，但cIONM仍是一种仍在不断发展的优良工具。文献中描述了cIONM的主动（acIONM）和被动（pcIONM）方法。目前，cIONM的主要应用领域是甲状腺手术（术中持续刺激迷走神经）和桥小脑角手术（术中持续刺激面神经或通过pcIONM分析神经放电信号）。在后一种手术中，也会对听神经进行持续监测。
