【摘要】 目的在累及运动区的胶质瘤切除术中,利用直接皮质刺激产生的运动诱发电位(MEP)去判断运动传导通路纤维的数量和功能,并分析其变化和术后病人四肢运动功能的关系。方法对42例累及运动区的胶质瘤病人,术中利用微弱电流直接刺激运动区皮质并记录产生的运动诱发电位,比较肿瘤切除前、中、后MEP的变化,分析肿瘤切除后MEP下降程度和术后3个月四肢运动功能的关系。结果切瘤后MEP较切瘤前波幅下降50%以上26例,其中出现严重运动功能障碍17例(65.4%),轻度运动功能障碍9例(34.5%);MEP下降50%以下16例,其中出现严重运动功能障碍2例(1.3%),轻度运动功能障碍10例(62.5%),基本正常4例(25.0%)。两组严重运动功能障碍经2χ检验,P<0.05,差异有统计学意义。结论术中行直接皮质刺激运动诱发电位监测可直接反映运动传导纤维的数量和功能,预测术后肢体运动情况。MEP波幅下降50%可作为将发生严重运动功能障碍的临界警戒点。更多还原

【Abstract】 Objective To record the motor evoked potential(MEP) induced by stimulating the motor cortex during the resection of glioma located in the motor cortex area,and observe variation of fiber number and function in the motor pathway,and analyze the relation of the variation to postoperative movement function of the extremities.Methods The motor cortex area was stimulated by weak current and MEP was recorded before,during and after the tumor removal in 42 patients with gliomas involving in the motor area.The postoperative disability of motor function was compared with the degree of the MEP amplitude decline 3 months after the operation.Results MEP amplitude decreased by more than 50% in 26 patients,of whom 17(65.4%) had severe extremity movement deficit,postoperatively,9(34.5%) mild movement disorder.The other 16 patients’ MEP reduced by less than 50%,of whom 2(1.3%) presented severe movement disorder,10(62.5%) mild extremity movement disorder,4(25.0%) was almost normal.The difference in severity of extremity movement disorder between the two groups was statistically significant by χ2 analysis(P<0.05).Conclusion MEP induced by direct motor cortex stimulation can be used to judge the integrity of the motor conduction fibers and foresee the limb movement function after the operation,and 50% decline of MEP should be an alarm for a possible severe motor deficit.更多还原