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颅脑和脊柱肿瘤手术中的多模式术中神经生理监测：一项描述性观察研究。

Multimodal Intraoperative Neurophysiological Monitoring in Cranial and Spinal Tumour Surgeries: A Descriptive Observational Study.

作者信息

Gupta Sangeeta, Siddiqui Saquib A, Sinha Upasna, Gupta Gaurav

机构信息

Physiology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND.

Neurosurgery, Mediversal Superspeciality Hospital, Patna, IND.

出版信息

Cureus. 2023 Nov 25;15(11):e49411. doi: 10.7759/cureus.49411. eCollection 2023 Nov.

DOI:10.7759/cureus.49411
PMID:38149147
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10750011/
Abstract

Intraoperative neurophysiological monitoring (IONM) involves monitoring the functional integrity of critical brain regions and pathways as well as identifying and preserving functionally viable neural tissues (mapping) during surgery using electrophysiological techniques. Multimodality combines various neurophysiological techniques to optimise diagnostic effectiveness and to improve the outcomes of the surgeries. The present study is a case series with comprehensive and illustrative descriptions of the neurophysiological changes in five neuromonitored cases of cranial and spinal cord tumour surgeries conducted with a multimodal approach. The cases were monitored with somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (TcMEP), and both free run and triggered electromyography (fEMG and tEMG). No false negative outcomes were identified in the cases studied as there was an association of absence of change in SSEP and TcMEP both, with no neurological deficit postoperatively. Two cases were identified as having true positive neuromonitoring alerts. No false positive alerts were found in any case. Multimodal monitoring using SSEP, TcMEP, and EMG (fEMG and tEMG) in cranial and spinal tumour surgeries can improve performance with fewer false-negative and false-positive results. Neuromonitoring approaches used in combination can provide reliable information regarding postoperative neurological outcomes.

摘要

术中神经生理监测（IONM）是指在手术过程中，运用电生理技术监测关键脑区和神经通路的功能完整性，以及识别和保留功能上可行的神经组织（图谱绘制）。多模态结合了多种神经生理技术，以优化诊断效果并改善手术结果。本研究是一个病例系列，对采用多模态方法进行的5例颅脑和脊髓肿瘤手术的神经生理变化进行了全面且具有说明性的描述。这些病例采用体感诱发电位（SSEP）、经颅运动诱发电位（TcMEP）以及自由运行和触发肌电图（fEMG和tEMG）进行监测。在所研究的病例中未发现假阴性结果，因为SSEP和TcMEP均无变化与术后无神经功能缺损相关。有2例被确定为具有真正的阳性神经监测警报。在任何病例中均未发现假阳性警报。在颅脑和脊髓肿瘤手术中使用SSEP、TcMEP和肌电图（fEMG和tEMG）进行多模态监测可以提高监测性能，减少假阴性和假阳性结果。联合使用的神经监测方法可以提供有关术后神经功能结果的可靠信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/9a0021483220/cureus-0015-00000049411-i19.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/61657bf4bd6e/cureus-0015-00000049411-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/1beaffc39664/cureus-0015-00000049411-i11.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/cb15dae57acf/cureus-0015-00000049411-i13.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/a5113948dd5d/cureus-0015-00000049411-i16.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/111f6da4f5db/cureus-0015-00000049411-i18.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/9a0021483220/cureus-0015-00000049411-i19.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/6a28acaeee49/cureus-0015-00000049411-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/b3d4bb8c478a/cureus-0015-00000049411-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/34871ff0e392/cureus-0015-00000049411-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/d0ca2d8a13fe/cureus-0015-00000049411-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/d956dafcb284/cureus-0015-00000049411-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/0a0c20a45aaf/cureus-0015-00000049411-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/710d9803033f/cureus-0015-00000049411-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/802ae3a4651e/cureus-0015-00000049411-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/f1e2e22ebd4e/cureus-0015-00000049411-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/61657bf4bd6e/cureus-0015-00000049411-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/1beaffc39664/cureus-0015-00000049411-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/6078e38750a6/cureus-0015-00000049411-i12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/cb15dae57acf/cureus-0015-00000049411-i13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/4c050d789743/cureus-0015-00000049411-i14.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/45da7f235ecc/cureus-0015-00000049411-i15.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/a5113948dd5d/cureus-0015-00000049411-i16.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/2f2007088f44/cureus-0015-00000049411-i17.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/111f6da4f5db/cureus-0015-00000049411-i18.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/182e/10750011/9a0021483220/cureus-0015-00000049411-i19.jpg

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