Kothbauer K, Deletis V, Epstein F J
Institute of Neurology and Neurosurgery, Beth Israel Medical Center, North Division, New York, NY 10128, USA.
Pediatr Neurosurg. 1997 May;26(5):247-54. doi: 10.1159/000121199.
Intraoperative monitoring of the functional integrity of the spinal cord during removal of intramedullary spinal cord lesions is an aid in intraoperative decision making and a primary tool for the prediction of neurological outcome. Motor evoked potential monitoring has become the neurophysiological monitoring technique of choice for that purpose. In the senior author's experience with over 130 pediatric patients suffering from intramedullary spinal cord tumors, the neurophysiological data of both motor and sensory evoked potentials was utilized in an integrative fashion. Motor evoked potentials, elicited with single transcranial electrical stimuli and recorded directly from the spinal cord with an electrode in the spinal epidural space, reflect the functional integrity of the corticospinal tract. Motor evoked potentials, elicited with a short train of transcranial electrical stimuli and recorded from limb muscles, reflect the functional integrity of the motor system from the cerebral cortex/white matter to beyond the neuromuscular junction. Both epidural and muscle motor evoked potentials correlated closely with postoperative neurological function. Both techniques provide fast, practical and reliable information on the functional integrity of the motor tracts of the spinal cord. No complications attributable to stimulation or recording occurred. Over time both the technique's reliable power of predicting clinical outcome and its practical versatility have altered the surgical approach in that gross total resections are more readily attempted as long as motor evoked potential data indicate the intact functional integrity of the corticospinal tract. This monitoring technique unquestionably had a favorable impact on neurological outcome.
在切除髓内脊髓病变过程中对脊髓功能完整性进行术中监测，有助于术中决策，也是预测神经功能转归的主要工具。运动诱发电位监测已成为实现该目的的首选神经生理监测技术。根据资深作者对130余例患有髓内脊髓肿瘤的儿科患者的经验，运动诱发电位和感觉诱发电位的神经生理数据以综合方式加以利用。通过单次经颅电刺激诱发并使用脊髓硬膜外间隙电极直接从脊髓记录的运动诱发电位，反映皮质脊髓束的功能完整性。通过短串经颅电刺激诱发并从肢体肌肉记录的运动诱发电位，反映从大脑皮质/白质到神经肌肉接头以外的运动系统的功能完整性。硬膜外和肌肉运动诱发电位均与术后神经功能密切相关。这两种技术均可提供有关脊髓运动传导束功能完整性的快速、实用且可靠的信息。未发生与刺激或记录相关的并发症。随着时间的推移，该技术预测临床转归的可靠能力及其实际通用性均改变了手术方式，只要运动诱发电位数据表明皮质脊髓束功能完整，就更易于尝试进行全切除。这种监测技术无疑对神经功能转归产生了有利影响。
