Fudickar Axel, Berndt Kai, Novak Klaus
Department of Anesthesiology and Intensive Care Medicine, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3/R3, 24105, Kiel, Germany.
Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, Wien, A-1090, Austria.
Childs Nerv Syst. 2025 Jan 8;41(1):88. doi: 10.1007/s00381-024-06739-4.
The background of this scoping review is that pediatric neurosurgery in the vicinity of motor pathways is associated with the risk of motor tract damage. By measuring transcranial electrical evoked potentials in muscles (electromyogram) or from the spinal cord (epidural D-wave) functional disorders and impending damage can be detected during surgery and countermeasures can be initiated. The objective was to summarize stimulation techniques of transcranial electrical stimulation and the success rate of motor evoked potentials exclusively in children undergoing neurosurgery.
The data source was a literature search for reports meeting the suitability criteria (original articles and case series including motor evoked potentials and pediatric neurosurgery).
Twenty-four articles meeting suitability criteria were retrieved. The most common primary electrode positions for electrical stimulation were at C3 vs. C4 and C1 vs. C2 according to the 10-20-system of EEG. Single trains of 1 to 9 pulses with voltages from 160 to 900 V and pulse durations from 50 to 500 µs were applied for voltage-controlled stimulation. Interstimulus intervals ranged from 0.1 to 9.9 ms. Signals were filtered with high-pass filters between 1.5 and 300 Hz and low-pass filters between 500 and 5000 Hz. The overall rate of successful stimulation and measurement was 90.5% (N = 769).
A broad range of stimulation parameters was used for transcranial electrical evoked potentials. Measurable potentials were obtained in most patients. Consideration of safety precautions is an important implication to avoid adverse events by application of high voltage to the motor cortex.
本范围综述的背景是，运动通路附近的小儿神经外科手术与运动束损伤风险相关。通过测量肌肉（肌电图）或脊髓（硬膜外D波）的经颅电诱发电位，可在手术期间检测功能障碍和即将发生的损伤，并可采取对策。目的是总结仅在接受神经外科手术的儿童中经颅电刺激的刺激技术和运动诱发电位的成功率。
数据来源是对符合适用性标准的报告进行文献检索（包括运动诱发电位和小儿神经外科手术的原始文章和病例系列）。
检索到24篇符合适用性标准的文章。根据脑电图的10-20系统，电刺激最常见的初级电极位置是C3对C4和C1对C2。电压控制刺激采用1至9个脉冲的单串，电压为160至900V，脉冲持续时间为50至500µs。刺激间隔范围为0.1至9.9ms。信号用1.5至300Hz的高通滤波器和500至5000Hz的低通滤波器进行滤波。成功刺激和测量的总发生率为90.5%（N = 769）。
经颅电诱发电位使用了广泛的刺激参数。大多数患者获得了可测量的电位。考虑安全预防措施是避免因向运动皮层施加高电压而导致不良事件的重要启示。
