神经电生理监测在椎管内肿瘤显微切除术中应用.docVIP

神经电生理监测在椎管内肿瘤显微切除术中的应用 　　【摘要】 目的：探讨神经电生理监测在椎管内肿瘤患者显微手术中的应用。方法：回顾分析2012年5月-2014年10月20例行显微切除术椎管内肿瘤患者的临床资料，术中以体感诱发电位、运动诱发电位和肌电图辅助手术操作。结果：肿瘤全切12例，大部分切除8例。术后病理诊断：脊膜瘤4例，表皮样囊肿5例，神经鞘瘤4例，神经纤维瘤1例，脂肪瘤2例，星形细胞瘤2例（Ⅰ级1例，Ⅱ级1例），囊性畸胎瘤2例。术后通过门诊或电话进行随访，随访时间为3～12个月，患者神经功能稳定或改善18例，1例复发，1例加重，无死亡病例。结论：术中神经电生理监测可及时预警术者，减少手术对脊髓功能的干扰，有效保护脊髓神经，避免术后脊髓功能进一步下降，提高肿瘤全切率及安全性，改善患者预后 【关键词】 神经电生理监测； 椎管内肿瘤； 手术 【Abstract】 Objective：To discuss the application of intraoperative neurophysiological monitoring in the microsurgery made for intraspinal tumor patients.Method：The clinical data of 20 patients with instraspinal tumor from May 2012 to October 2014 were analyzed retrospectively. The data suggested that all of the 20 cases had adopted microscopic resection and the surgeries were assisted with somatosensory evoked potentials，motion evoked potential and electromyogram.Result：12 cases tumors were totally resected and 8 cases tumors were partially resected.Postoperative pathological analysis 4 spinal meningiomas，5 epidermoid cysts，4 neurilemmomas，1 neurofibroma，2 lipomas，2 astrocytomas（1 grade Ⅰ astrocytoma and 1 grade Ⅱ astrocytoma），2 cystic teratomas.3-12 months follow-up by outpatient service and telephone back-visiting after the surgeries suggested that 18 patients neurological function had become stable or had been improved，1 recurred，1 exacerbated and no death case.Conclusion：Intraoperative neurophysiological monitoring can forewarn surgeons timely and reduce surgical interference to the spinal cord function，can protect spinal nerves effectively，avoid spinal cord function dropping after the surgeries， increase total removal rate and security and improve the patients prognosis. 【Key words】 Neurophysiological monitoring； Intraspinal tumor； Surgery 髓内肿瘤可导致患者出现肢体活动障碍、麻木、疼痛、感觉异常、大小便功能障碍，手术切除作为椎管内肿瘤有效的治疗方法常会因损伤脊髓的神经而引发各种术后并发症。术中唤醒作为避免术中损伤脊髓和神经的一种方法，会增加手术风险和患者痛苦，而且麻醉唤醒存在过程复杂、风险大等不利因素。随着神经电生理监测技术应用于椎管内肿瘤手术，使得患者术后脊髓功能的完整性及术后躯体运动、感觉功能以及二便功能的保护成为可能。目前常用的术中神经电生理监测的方法主要包括体感诱发电位somatosensory evoked pot