Whittle I R, Johnston I H, Besser M
Aust N Z J Surg. 1986 Apr;56(4):309-17. doi: 10.1111/j.1445-2197.1986.tb06155.x.
The experience with cortical somatosensory evoked potential (SEP) recording during 13 cases of spinal neurological surgery is described. Good quality cortical SEPs were obtained in eight patients with a variety of intradural and extradural spinal disorders. The short latency components of these waveforms were stable during anaesthesia with nitrous oxide, 0.5% halothane and fentanyl. Fluctuations in signal amplitude were, however, common. In the one patient in whom the cortical SEP waveform was distorted intra-operatively, there was an increased neurological deficit. In one normal and four patients with impairment of dorsal column function, no intra-operative cortical SEP was recorded. In these five patients spinal SEPs were recorded rostral to the level of spinal disease. Monitoring spinal cord function using cortical SEPs can provide useful neurophysiological information, however, there are limitations to its utility. These relate to difficulties in signal acquisition, the low signal amplitude, attenuation of the signal during intramedullary surgery and uncertainties in signal interpretation. All these problems are exacerbated if the patient has a pre-operative clinical somatosensory deficit. Although most of these problems can be overcome using spinal SEP monitoring, intra-operative SEP recordings are not an infallible guide to spinal cord integrity since they reflect the functional status of only the dorsal column-medial lemniscus pathway.
本文描述了13例脊柱神经外科手术中皮层体感诱发电位（SEP）记录的经验。8例患有各种硬膜内和硬膜外脊柱疾病的患者获得了高质量的皮层SEP。在使用一氧化二氮、0.5%氟烷和芬太尼麻醉期间，这些波形的短潜伏期成分稳定。然而，信号幅度波动很常见。术中皮层SEP波形畸变的1例患者神经功能缺损增加。1例正常患者和4例背柱功能受损患者术中未记录到皮层SEP。在这5例患者中，在脊髓疾病水平上方记录到脊髓SEP。使用皮层SEP监测脊髓功能可提供有用的神经生理学信息，然而，其效用存在局限性。这些局限性与信号采集困难、信号幅度低、髓内手术期间信号衰减以及信号解释的不确定性有关。如果患者术前存在临床体感缺陷，所有这些问题都会加剧。虽然使用脊髓SEP监测可以克服这些问题中的大多数，但术中SEP记录并非脊髓完整性的可靠指标，因为它们仅反映背柱-内侧丘系通路的功能状态。
