Kothbauer K, Schmid U D, Seiler R W, Eisner W
Department of Neurosurgery, Inselspital, University of Bern, Switzerland.
Neurosurgery. 1994 Apr;34(4):702-7; discussion 707. doi: 10.1227/00006123-199404000-00020.
A set of standard techniques to monitor the motor and sensory function of the cauda equina is proposed for surgery in the lumbosacral spinal canal for the release of a tethered cord or the removal of a neoplasm. Continuous loudspeaker-controlled recording of electromyographic activity in four leg muscles of both sides supplied the surgeon with immediate feedback on injury to any of the motor roots from the second lumbar to the fourth sacral segment. Continuous recording of tibial nerve somatosensory evoked potentials yielded information about the functional state of parts of the lumbosacral sensory pathways. Motor roots could be identified by electrical stimulation in the operating field with bipolar stimulation forceps and recording of compound muscle action potentials from the leg muscles. Sensory nerve roots could be identified by nerve root somatosensory evoked potentials recorded from the scalp after the electrical stimulation of the exposed nerve. This set-up is a combination of previously developed monitoring techniques and provides the surgeon with functional information: 1) continuous feedback on the state of the endangered motor and sensory function of the cauda equina; and 2) rapid anatomical identification of nerve roots and their distinction from fibrous or neoplastic structures.
针对腰骶椎管内松解脊髓栓系或切除肿瘤的手术，提出了一套用于监测马尾神经运动和感觉功能的标准技术。通过连续用扬声器控制记录双侧四条腿部肌肉的肌电活动，可为外科医生提供从第二腰椎至第四骶椎节段任何运动神经根损伤的即时反馈。连续记录胫神经体感诱发电位可得出有关腰骶感觉通路各部分功能状态的信息。在手术区域用双极刺激钳进行电刺激并记录腿部肌肉的复合肌肉动作电位，可识别运动神经根。在对暴露的神经进行电刺激后，从头皮记录神经根体感诱发电位，可识别感觉神经根。此设置是先前开发的监测技术的组合，可为外科医生提供功能信息：1）对马尾神经濒危运动和感觉功能状态的连续反馈；2）神经根的快速解剖识别及其与纤维或肿瘤结构的区分。
