持续的交叉 (两侧) 电机唤起潜力 (MEP) 反应是否代表内运动管监测的技术故障? 一个案例示例和实际解决方案
Marshall F Wilkinson1, Kristine Pederson2, Philip Kawalec2
1Section of Neurosurgery Health Sciences Centre, GB 1 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada. mwilkinson@hsc.mb.ca.
内外科手术需要谨慎的运动唤起潜力 (MEP) 刺激强度,以防止假阴性. 在这种情况下,安装延迟指导,而不是交叉MEP,可靠地确定了适当的刺激强度.
科学领域:
- 神经外科 神经外科
- 神经生理学 神经生理学
- 麻醉 麻醉是一种麻醉.
背景情况:
- 运动唤起潜能 (MEP) 对于在内手术过程中监测运动通路完整性至关重要.
- 不适当的刺激强度可能导致错误的负MEP结果,可能会危及患者的安全.
- 两侧交叉的MEP反应往往被误解为表明过度刺激强度.
研究的目的:
- 描述一个持续交叉的MEP响应误导性地暗示了最高最大刺激强度的情况.
- 介绍一种替代方法来指导MEP刺激强度选择在内外科手术期间.
主要方法:
- 在 suboccipital craniotomy 期间,双边跨电气MEP监测在全静脉麻醉下进行.
- 使用特定的刺激组合 (C4-Cz和C3-Cz) 记录了来自左手和右手的MEP反应.
- 使用MEP的发病延迟来指导选择适当的刺激强度,以达到表面的值.
主要成果:
- 在使用C3-Cz组合时,观察到持久的交叉MEP反应,刺激强度低 (94V/166mA).
- 来自对方手 MEPs 的启动延迟测量被用来确定最佳刺激强度 (约. 96 V/172 mA) 的情况.
- 这种强度是在MEP发作的延迟至少比最大刺激强度的最短延迟长2ms时选择的,允许在没有运动缺陷的情况下进行成功的手术.
结论:
- 反侧手MEP可以可靠地用于手术内监测,即使存在交叉反应.
- 启动延迟指南提供了一种定量方法来验证MEP刺激强度,确保内手术期间的安全性和有效性.
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