Strauss C, Romstöck J, Nimsky C, Fahlbusch R
Department of Neurosurgery, University Erlangen-Nuremberg, Erlangen, Germany.
J Neurosurg. 1993 Sep;79(3):393-9. doi: 10.3171/jns.1993.79.3.0393.
Intraoperative electrical identification of motor areas within the floor of the fourth ventricle was successfully carried out in a series of 10 patients with intrinsic pontine lesions and lesions infiltrating the brain stem. Direct electrical stimulation was used to identify the facial colliculus and the hypoglossal triangle before the brain stem was entered. Multichannel electromyographic recordings documented selective stimulation effects. The surgical approach to the brain stem was varied according to the electrical localization of these structures. During removal of the lesion, functional integrity was monitored by intermittent stimulation. In lesions infiltrating the floor of the fourth ventricle, stimulation facilitated complete removal. Permanent postoperative morbidity of facial or hypoglossal nerve dysfunction was not observed. Mapping of the floor of the fourth ventricle identifies important surface structures and offers a safe corridor through intact nervous structures during surgery of brain-stem lesions. Reliable identification is particularly important in mass lesions with displacement of normal topographical anatomy.
在一系列10例患有桥脑固有病变及浸润脑干病变的患者中，成功进行了第四脑室底部运动区的术中电识别。在进入脑干之前，使用直接电刺激来识别面神经丘和舌下神经三角。多通道肌电图记录记录了选择性刺激效果。根据这些结构的电定位改变了脑干的手术入路。在切除病变过程中，通过间歇性刺激监测功能完整性。在浸润第四脑室底部的病变中，刺激有助于完全切除。未观察到术后永久性面神经或舌下神经功能障碍的发病率。第四脑室底部的图谱识别出重要的表面结构，并在脑干病变手术期间提供了一条穿过完整神经结构的安全通道。在正常局部解剖结构移位的肿块病变中，可靠的识别尤为重要。
