全身麻醉下运动诱发电位对邻近运动功能区胶质瘤手术后运动障碍的预测价值

doi:10.3969/j.issn.1672-6731.2020.11.006

摘要/Abstract

摘要：

目的探讨全身麻醉状态下邻近运动功能区胶质瘤手术中运动诱发电位（MEP）监测对术后新发/加重运动障碍的预测价值。方法以2019年10月至2020年3月接受邻近运动功能区胶质瘤手术的49例患者为研究对象，术中采取经颅电刺激（TES）、直接皮质电刺激（DCS）或皮质下电刺激（SCS），记录对侧肢体和面部肌肉的运动诱发电位，以定位大脑运动皮质和皮质脊髓束。运动诱发电位的预警标准为TES-MEP波幅降低≥ 50%或DCS-MEP波幅降低≥ 50%；以英国医学研究学会（MRC）肌力分级为“金标准”，计算TES-MEP、DCS-MEP和SCS-MEP预测术后新发/加重运动障碍的灵敏度与特异度、阳性预测值与阴性预测值。结果 49例患者均诱发出TES-MEP，真阳性2例、真阴性44例、假阴性3例；有11例诱发出DCS-MEP，真阳性1例、真阴性10例；TES-MEP预测术后新发/加重运动障碍灵敏度为2/5、特异度100%（44/44）、阳性预测值为2/2、阴性预测值93.62%（44/47）；DCS-MEP预测灵敏度为1/1、特异度10/10，阳性预测值为1/1、阴性预测值10/10。共5例（10.20%）患者术后出现新发/加重运动障碍，随访至术后3个月，1例肌力恢复正常；TES-MEP预测灵敏度为2/4、特异度100%（45/45），阳性预测值为2/2、阴性预测值95.74%（45/47）；DCS-MEP预测灵敏度为1/1、特异度10/10，阳性预测值为1/1、阴性预测值10/10。结论术中TES-MEP监测假阴性率较高，DCS-MEP与术后运动功能预后一致性较高，但是由于无法显露中央前回皮质使其应用率较低。推荐联合应用TES-MEP、DCS-MEP和SCS-MEP判断运动传导通路完整性，效果更佳。

关键词: 麻醉, 全身, 诱发电位, 运动, 电刺激, 神经胶质瘤, 神经外科手术

Abstract:

Objective To determine the predictive value of intraoperative motor-evoked potential(MEP) on the muscle strength of patients undergoing glioma close to motor area under general anesthesia. Methods A total of 49 patients were included in this study from October 2019 to March 2020. The transcranial electrical stimulation (TES), direct cortical stimulation (DCS) and subcortical stimulation (SCS) were used to locate the motor cortex and corticospinal tract (CST), and to assess the functional integrity of motor system. A decrease of ≥ 50% of the baseline amplitude of TES or DCS was regarded as an alarm criteria. Muscle strength was evaluated with "gold standard" the Medical Research Council (MRC) scale before and after operation. Results Combined application of TES-MEP, DCS-MEP and SCS-MEP had better results in judging the integrity of motor conduction pathway. The sensitivity and specificity of TES-MEP were 2/5 and 100% (44/44), the positive predictive value and negative predictive value were 2/2 and 93.62% (44/47), respectively. The sensitivity and specificity of DCS-MEP were 1/1 and 10/10, the positive predictive value and negative predictive value were 1/1 and 10/10, respectively. There were 5 cases (10.20%) with new dyskinesia after operation. After 3 months of follow-up, muscle strength of one case returned to normal. The sensitivity and specificity of TES-MEP were 2/4 and 100% (45/45), the positive predictive value and negative predictive value were 2/2 and 95.74% (45/47), respectively. The sensitivity and specificity of DCS-MEP were 1/1 and 10/10, the positive predictive value and negative predictive value were 1/1 and 10/10, respectively. Conclusions This study indicates a high false negative rate after TES-MEP, DCS-MEP results were more consistent with postoperative motor function results, but the utilization rate was low due to the lack of exposure to the precentral gyrus cortex. Combined application of TES-MEP, DCS-MEP and SCS-MEP are more effective in judging the integrity of motor conduction pathway.

Key words: Anesthesia, general, Evoked potentials, motor, Electric stimulation, Glioma, Neurosurgical procedures

宗轶烜, 沈琦, 肖明, 方媛, 毛庆. 全身麻醉下运动诱发电位对邻近运动功能区胶质瘤手术后运动障碍的预测价值[J]. 中国现代神经疾病杂志, 2020, 20(11): 962-969.

ZONG Yi-xuan, SHEN Qi, XIAO Ming, FANG Yuan, MAO Qing. Dyskinesia predictive value of motor-evoked potential in gliomas surgery close to motor area under general anesthesia[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 962-969.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I11/962

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2 全身麻醉下运动诱发电位对邻近运动功能区胶质瘤手术后运动障碍的预测价值

Dyskinesia predictive value of motor-evoked potential in gliomas surgery close to motor area under general anesthesia

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2 全身麻醉下运动诱发电位对邻近运动功能区胶质瘤手术后运动障碍的预测价值

Dyskinesia predictive value of motor-evoked potential in gliomas surgery close to motor area under general anesthesia

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