Zileli M, Coşkun E, Yegül I, Uyar M
Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey.
Acta Neurochir Suppl. 1995;64:92-6. doi: 10.1007/978-3-7091-9419-5_20.
During percutaneous cordotomy, impedance monitoring and electric stimulation have been widely used to enable a precise localization of the lesion electrode. The purpose of this study was to examine the possibility that the usage of additional electrophysiological techniques could help in improving the precision of the placement of the lesion electrode. Fourteen patients were monitored with 4 different techniques during CT-guided percutaneous cordotomy: 1) Median nerve somatosensory evoked potentials (mSEP): median nerve stimulation with recording from the scalp. 2) Spinal cord evoked potentials (SCEP): median nerve stimulation with recording via the cordotomy electrode. 3) Spinothalamic evoked potentials (SthEP): stimulation via the cordotomy electrode and recording from the scalp. Ipsilateral and contralateral mSEPs and SCEPs did not change after the lesion. SthEPs showed a significant decrease in 10 of 12 patients provided the stimulus intensity was kept below that producing a motor response (approx 0.5-1 mA). There was no obvious relationship between changes of the evoked potentials and the clinical outcome of the cordotomy. Our results suggest that there may be a relationship between the extent of the lesion and the decrease of the spinothalamic evoked potentials.
在经皮脊髓切断术中，阻抗监测和电刺激已被广泛用于精确确定损伤电极的位置。本研究的目的是探讨使用额外的电生理技术是否有助于提高损伤电极放置的精度。在CT引导下的经皮脊髓切断术中，对14名患者采用4种不同技术进行监测：1）正中神经体感诱发电位（mSEP）：刺激正中神经并在头皮记录。2）脊髓诱发电位（SCEP）：刺激正中神经并通过脊髓切断术电极记录。3）脊髓丘脑诱发电位（SthEP）：通过脊髓切断术电极刺激并在头皮记录。损伤后同侧和对侧的mSEP和SCEP均未改变。在12名患者中有10名患者的SthEP显示明显下降，前提是刺激强度保持在产生运动反应的强度以下（约0.5 - 1 mA）。诱发电位的变化与脊髓切断术的临床结果之间没有明显关系。我们的结果表明，损伤范围与脊髓丘脑诱发电位的下降之间可能存在关联。
