Guérit J M
Clinical Neurophysiology Unit, Cliniques Saint-Luc, University of Louvain Medical School, Brussels, Belgium.
Electroencephalogr Clin Neurophysiol. 1998 Jan;106(1):1-21. doi: 10.1016/s0013-4694(97)00077-1.
This review considers the main principles and indications of EEG and evoked potential (EP) neuromonitoring in the operating room. Neuromonitoring has a threefold purpose: to warn the surgeon that he has to adjust his strategy, to confirm his decision, and to help him improve subsequent procedures. The pathophysiology of intraoperative events liable to alter the EEG or the EPs is first considered. The usefulness of neuromonitoring in preventing neurological complication relies on its ability to detect neurological dysfunction at a reversible stage. This applies especially to ischemia and compressive damage. The anesthetic influences on EEG and EPs are then considered. Knowledge of them is essential to disentangle these neurophysiological alterations due to intraoperative events from those merely due to anesthesia and to use neurophysiological parameters to evaluate the depth of anesthesia. Third, the main indications and limitations of neuromonitoring are considered: prevention of ischemic brain or spinal cord damage, prevention of mechanical injuries of the brain, spinal cord or peripheral nerve, and localization of the motor cortex in cortical neurosurgery or of cranial nerves in posterior fossa surgery. Finally, the 3 levels of neuromonitoring (neurophysiological feature extraction, neurophysiological pattern recognition, clinical integration of the neurophysiological patterns) are discussed together with the rules that should guide the dialogue between the surgeon, the anesthesiologist, and the neurophysiologist.
本综述探讨了手术室中脑电图（EEG）和诱发电位（EP）神经监测的主要原则及适应证。神经监测有三个目的：警告外科医生其必须调整策略、确认其决策并帮助其改进后续手术操作。首先考虑了术中可能改变EEG或EP的事件的病理生理学。神经监测在预防神经并发症方面的效用依赖于其在可逆阶段检测神经功能障碍的能力。这尤其适用于缺血和压迫性损伤。接着考虑了麻醉对EEG和EP的影响。了解这些对于区分术中事件导致的神经生理改变与单纯由麻醉引起的改变，并利用神经生理参数评估麻醉深度至关重要。第三，考虑了神经监测的主要适应证和局限性：预防缺血性脑或脊髓损伤、预防脑、脊髓或周围神经的机械性损伤，以及在皮质神经外科手术中定位运动皮层或在后颅窝手术中定位颅神经。最后，讨论了神经监测的三个层次（神经生理特征提取、神经生理模式识别、神经生理模式的临床整合）以及指导外科医生、麻醉医生和神经生理学家之间对话的规则。
