摘要：

目的 初步探讨术中直接电刺激运动诱发电位（DES-MEP）在脑干肿瘤手术中对运动功能的保护作用。方法 纳入2017年1月至2020年5月行脑干肿瘤切除术患者共136例，术中常规行电生理监测联合神经导航（对照组，68例）或常规电生理与DES-MEP监测联合神经导航（联合监测组，68例），根据手术前后肌力变化（Lovett肌力分级）判断是否存在新发运动障碍，以术中DES-MEP监测和术后运动功能评价结果判断DES-MEP监测的真阳性、假阳性、真阴性、假阴性，并计算其预测术后运动功能预后的灵敏度与特异度、阳性预测值与阴性预测值、准确率。结果 联合监测组患者术后2周出现严重新发运动障碍（Lovett肌力分级降低≥ 2级）的比例为16.18%（11/68），低于对照组[32.35%（22/68）；χ²=4.841，P=0.028]。DES-MEP监测真阳性者44例、假阳性4例、真阴性7例、假阴性13例，术后预测严重新发运动障碍的灵敏度为77.19%（44/57）、特异度7/11，阳性预测值91.67%（44/48）、阴性预测值35%（7/20），诊断准确率为75%（51/68）。结论 脑干肿瘤切除手术中常规电生理监测与DES-MEP监测技术联合应用，可实现对脑干运动功能的保护，弥补现阶段术中电生理监测技术在皮质脊髓束功能保护方面的不足。

关键词: 脑干肿瘤, 锥体束, 电刺激, 诱发电位,运动, 监测,手术中

Abstract:

Objective Preliminary study on the protective effect of intraoperative direct electrical stimulation motor-evoked potential (DES-MEP) on motor function during brainstem tumor surgery. Methods Total 136 patients with brainstem tumor surgery from January 2017 to May 2020 were enrolled, including 68 patients treated with intraoperative routine electrophysiological monitoring combined with neuronavigation and 68 patients with DES-MEP combined with neuronavigation on the basis of routine electrophysiological monitoring. According to the changes of muscle strength (Lovett Muscle Strength Classification) before and after operation, the patients were judged to have new dyskinesia motor function or not. The true positive, false positive, true negative and false negative were judged by DES-MEP monitoring and postoperative motor function prognosis. The sensitivity and specificity, positive predictive value and negative predictive value, and accuracy of DES-MEP monitoring results in predicting postoperative motor function prognosis were calculated. Results Patients undergoing DES-MEP combined with routine electrophysiological monitoring had 16.18% (11/68) of severe new dyskinesia (Lovett Muscle Strength Classification reduction ≥ 2 grade) 2 weeks after surgery, which was lower than patients undergoing routine electrophysiological monitoring[32.35% (22/68); χ²=4.841, P=0.028]. There were 44 true positive cases, 4 false positive cases, 7 true negative cases, and 13 false negative cases detected by DES-MEP. The sensitivity and specificity of DES-MEP were 77.19% (44/57) and 7/11, the positive predictive value and negative predictive value of DES-MEP were 91.67% (44/48) and 35% (7/20), and accuracy of DES-MEP was 75% (51/68), respectively. Conclusions The application of DES-MEP in brainstem tumor surgery can effectively protect the brainstem motor function and make up for the deficiency of intraoperative neural monitoring technology in the protection of brainstem corticospinal tract function.

Key words: Brain stem neoplasms, Pyramidal tracts, Electric stimulation, Evoked potentials, motor, Monitoring, intraoperative