Combined monitoring of evoked potentials during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms

摘要

＜正＞ Background Neurophysiologic monitoring during surgery is to prevent permanent neurological injury resulting fromsurgical manipulation.To improve the accuracy and sensitivity of intraoperative neuromonitoring,combined monitoring oftranscranial electrical stimulation motor evoked potentials（TES-MEPs）,somatosensory evoked potentials（SSEPs）andbrainstem auditory evoked potentials（BAEPs）was attempted in microsurgery for lesions adjacent to the brainstem andintracranial aneurysms.Methods Monitoring of combined TES-MEPs with SSEPs was attempted in 68 consecutive patients with lesionsadjacent to the brainstem as well as intracranial aneurysms.Among them,31 patients（31 operations,28 of posteriorcranial fossa tumors,3 of posterior circulation aneurysms）were also subjected to monitoring of BAEPs.The correlationof monitoring results and clinical outcome was studied prospectively.Results Combined monitoring of evoked potentials（EPs）was done in 64（94.1%）of the 68 patients.MEPs monitoringwas impossible for 4 patients（5.9%）.No complication was observed during the combined monitoring in all the patients.In45（66.2%）of the 68 patients,EPs were stable,and they were neurologically intact.Motor dysfunction was detected byMEPs in 8 patients,SSEPs in 5,and BAEPs in 4,respectively.Conclusions A close relationship exists between postoperative motor function and the results of TES-MEPs monitoringTES-MEPs are superior to SSEPs and BAEPs in detecting motor dysfunction,but combined EPs serve as a safe,effective and invasive method for intraoperative monitoring of the function of the motor nervous system.Monitoring ofcombined EPs during microsurgery for lesions adjacent to the brainstem and intracranial aneurysms may detectpotentially hazardous maneuvers and improve the safety of subsequent procedures