Surgical Neurophysiology Program, Department of Neurology, Keck Medical Center of USC, University of Southern California, Los Angeles, California, U.S.A.
J Clin Neurophysiol. 2022 Sep 1;39(6):513-518. doi: 10.1097/WNP.0000000000000796. Epub 2020 Nov 30.
Intraoperative neurophysiological monitoring has been well documented as an adjunctive technique that significantly decreases the risk of developing inadvertent sensory and motor deficits during cranial and spine surgeries. The ability to detect neurologic problems intraoperatively depends largely on accurately identifying changes that occur in somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during each procedure. Therefore, obtaining accurate and reproducible SSEP and MEP data during the initial setup is paramount for intraoperative monitoring. In 2007, Chen et al. found the overall success rate for establishing reliable MEP responses to be 94.8% in the upper extremities and 66.6% in the lower extremities. Since then, the success rate of obtaining baseline sensory and motor evoked potential responses has not been specifically reevaluated. The main goal of this study was to evaluate the current success rates of obtaining adequate SSEP and MEP baseline data in the current era, as well as take a closer look into some of the factors that can reduce the success rates.
Somatosensory evoked potential and MEP monitoring was attempted in a total of 695 consecutive brain and spine surgeries performed by neurosurgeons and orthopedic surgeons between January 2010 and July 2011. Somatosensory evoked potential and MEP baseline data were obtained after initiation of general anesthesia and before skin incision. The primary measure is the ability to obtain adequate SSEP and MEP baseline in each extremity. A secondary measure was to stratify the success rate based on preoperative diagnosis.
Six hundred ninety-five consecutive cranial and spinal cases that required intraoperative monitoring were reviewed. Baseline upper extremity SSEPs were successfully obtained in 679 cases (98.1%), and baseline lower extremity SSEPs were successfully obtained in 626 cases (90.1%). However, if the preoperative diagnosis was in the category spine trauma or spine infection, the success rate of obtaining adequate baseline in the lower extremities dropped to around 60% for both SSEPs and MEPs.
The success rates of obtaining adequate baseline SSEP and MEP data are overall higher than previously reported. Preoperative diagnosis like spinal infection or trauma may predict lower success rates for acquiring adequate baseline SSEPs and MEPs.
术中神经生理监测已被充分证明是一种辅助技术，可显著降低颅颈和脊柱手术中无意发生感觉和运动功能缺陷的风险。术中检测神经问题的能力在很大程度上取决于准确识别在每个手术过程中体感诱发电位（SSEP）和运动诱发电位（MEP）中发生的变化。因此，在初始设置期间获得准确和可重复的 SSEP 和 MEP 数据对于术中监测至关重要。2007 年，Chen 等人发现上肢建立可靠 MEP 反应的总成功率为 94.8%，下肢为 66.6%。此后，尚未专门重新评估获得基线感觉和运动诱发电位反应的成功率。本研究的主要目标是评估当前获得足够的 SSEP 和 MEP 基线数据的成功率，以及更深入地研究一些可能降低成功率的因素。
2010 年 1 月至 2011 年 7 月，神经外科医生和矫形外科医生对总共 695 例连续脑和脊柱手术进行了体感诱发电位和 MEP 监测。在全身麻醉启动后和皮肤切口前获得体感诱发电位和 MEP 基线数据。主要衡量标准是在每个肢体上获得足够的 SSEP 和 MEP 基线的能力。次要衡量标准是根据术前诊断对成功率进行分层。
回顾了 695 例连续的颅颈和脊柱病例，这些病例需要术中监测。679 例（98.1%）成功获得了上肢 SSEP 的基线，626 例（90.1%）成功获得了下肢 SSEP 的基线。然而，如果术前诊断属于脊柱创伤或脊柱感染类别，则在这两种情况下，下肢获得足够基线的成功率均降至 60%左右。
获得足够的 SSEP 和 MEP 数据基线的成功率总体上高于之前的报告。像脊柱感染或创伤这样的术前诊断可能预示着获得足够的 SSEP 和 MEP 基线的成功率较低。
