inomed Neurocare Ltd, London, United Kingdom.
Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom.
Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):373-382. doi: 10.1093/ons/opaa407.
BACKGROUND: A recent influx of intraoperative technology is being used in neurosurgery, but few reports investigate the accuracy and safety of these technologies when used simultaneously. OBJECTIVE: To assess the ability to use an electromagnetic navigation system alongside multimodal intraoperative neurophysiological monitoring (IONM). METHODS: Single-institution prospective cohort study of patients requiring craniotomy for brain tumor resection operated using an electromagnetic navigation system (AxiEM, Medtronic®). motor evoked potentials, somatosensory evoked potentials (SSEPs), electroencephalography, and electromyography were recorded and analyzed with AxiEM on (with/without filters) and off. The neurological outcomes of the patients were recorded. RESULTS: A total of 15 patients were included (8 males/7 females, mean age 52.13 yr). Even though the raw acquisition is affected by the electromagnetic field (particularly SSEPs), no significant difference was detected in the morphology, amplitude, and latency of the different monitoring modalities (AxiEM off vs on) after the appropriate software filter application. Adjustments to the frequency of SSEP stimulation and number of averages, and reductions to the low-pass filters were applied. Notch filters were used appropriately and changes to the physical setup of the IONM and electromagnetic navigation system equipment reduced noise. Postoperatively, none of the patients developed new focal deficits; 7 patients showed improvement in their motor deficit (4 recovered fully). CONCLUSION: The information provided by the IONM in intracranial neurosurgery patients whilst also using electromagnetic navigation systems is reliable for monitoring, mapping, and detecting intraoperative complications, provided that the appropriate software filters and tools are applied.
背景:最近有大量的术中技术被应用于神经外科,但很少有报道研究这些技术同时使用时的准确性和安全性。
目的:评估在多模态术中神经生理监测(IONM)的同时使用电磁导航系统的能力。
方法:对需要开颅切除脑肿瘤的患者进行单中心前瞻性队列研究,这些患者使用电磁导航系统(AxiEM,Medtronic®)进行手术。记录和分析使用和不使用(带/不带滤波器)电磁导航系统时的运动诱发电位、体感诱发电位(SSEP)、脑电图和肌电图。记录患者的神经功能结局。
结果:共纳入 15 例患者(8 例男性/7 例女性,平均年龄 52.13 岁)。尽管原始采集受到电磁场的影响(特别是 SSEP),但在适当的软件滤波器应用后,不同监测模式(电磁导航系统关闭与开启)的形态、幅度和潜伏期没有发现显著差异。对 SSEP 刺激频率和平均值数量进行了调整,并降低了低通滤波器。适当使用陷波滤波器,并对 IONM 和电磁导航系统设备的物理设置进行调整以减少噪声。术后,没有患者出现新的局灶性缺陷;7 例患者运动缺陷改善(4 例完全恢复)。
结论:在颅内神经外科患者中同时使用电磁导航系统时,IONM 提供的信息对于监测、映射和检测术中并发症是可靠的,前提是应用适当的软件滤波器和工具。
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