Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan.
Department of Orthopedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, 573-1010, Hirakata City, Osaka, Japan.
Childs Nerv Syst. 2023 Jun;39(6):1603-1610. doi: 10.1007/s00381-023-05900-9. Epub 2023 Mar 4.
Stable intraoperative neurophysiology monitoring of infants, especially very young infants, is challenging. In this study, motor evoked potentials (MEPs), the bulbocavernosus reflex (BCR), and somatosensory evoked potentials (SEPs) were simultaneously monitored in infants with lumbosacral lipomas, and these methods were compared retrospectively.
A total of 21 surgeries performed for lumbosacral lipoma in patients less than 1 year old were studied. The mean age at surgery was 133.8 days (range 21-287 days; ≤ 120 days: 9 cases, > 120 days: 12 cases). Transcranial MEPs were measured in the anal sphincter and gastrocnemius, and tibialis anterior and other muscles were added as needed. The BCR was measured by the electromyogram of the anal sphincter muscle with stimulation of the pubic region, and SEPs were measured from the waveforms of stimulation of the posterior tibial nerves.
For the BCR, stable potentials could be recorded for all 9 cases at ≤ 120 days of age. In contrast, for MEPs, stable potentials could be recorded in only 4 of 9 cases (p < 0.05). For all patients > 120 days of age, MEPs and the BCR were measurable. SEPs were undetectable in some patients regardless of age.
The BCR could be more consistently measured than MEPs in infant patients with lumbosacral lipoma at ≤ 120 days of age.
稳定的术中神经生理学监测对于婴儿，尤其是非常年幼的婴儿来说是具有挑战性的。在这项研究中，对腰骶部脂肪瘤患儿同时进行运动诱发电位（MEP）、球海绵体反射（BCR）和体感诱发电位（SEP）监测，并进行回顾性比较。
共研究了 21 例年龄小于 1 岁的腰骶部脂肪瘤患儿手术。手术时的平均年龄为 133.8 天（范围 21-287 天；≤120 天：9 例，>120 天：12 例）。经颅 MEPs 在肛门括约肌和腓肠肌处测量，必要时可增加胫骨前肌和其他肌肉。BCR 通过刺激耻骨区测量肛门括约肌肌电图，SEP 通过刺激后胫神经的波形测量。
对于 BCR，所有 9 例≤120 天的患儿均能记录到稳定的电位。相比之下，9 例中的 4 例（p<0.05）MEPs 能记录到稳定的电位。对于所有年龄>120 天的患儿，MEPs 和 BCR 均可以测量。无论年龄大小，有些患儿的 SEP 无法检测到。
对于≤120 天的腰骶部脂肪瘤患儿，BCR 比 MEP 更能稳定地测量。
