Monitoring of motor evoked potentials with high intensity repetitive transcranial electrical stimulation during spinal surgery

被引:8
作者
Haghighi S.S. [1 ]
机构
[1] Clinical Neurodiagnostic Department, Sharp Memorial Hospital, San Diego, CA 92123
关键词
Compound muscle action potential; Motor evoked potentials; Propofol; Transcranial electrical stimulation;
D O I
10.1023/A:1021210507928
中图分类号
学科分类号
摘要
Objective. Clinical utility of high voltage repetitive transcranial electrical stimulation (TES) was investigated in 46 patients undergoing spine surgery. Methods. During spinal surgery, motor evoked potentials (MEPs) were recorded from upper or lower limb muscles following high voltage repetitive TES of motor cortex under propofol and opioid/N2O anesthesia. Results. The number of responses evoked by the double pulse stimulation was significantly higher than the single pulse stimulation. A similar finding was obtained when repetitive and single pulse stimulation was compared. Compound muscle action potentials (CMAPs) were recorded from upper and lower limbs in 4 patients with cervical spine myelopathy. The CMAP was absent on the affected side in 1 patient, which improved slightly after decompression. Radiculopathy was clinically present in 6 patients undergoing posterior lumbar decompression and fusion. No improvement of MEP was noted intraoperatively after spinal decompression and instrumentation. Conclusion. The findings suggest that intraoperative MEP monitoring is feasible method, however, its immediate prognostic value for adequacy of neuronal decompression and improvement requires further studies with larger patient population.
引用
收藏
页码:301 / 308
页数:7
相关论文
共 21 条
[1]  
Aglio L.S., Romero R., Desai S., Et al., The use of transcranial magnetic stimulation for monitoring descending spinal cord motor function, Clin Electroencephalogr, 33, pp. 30-41, (2002)
[2]  
Merton P.A., Morton H.B., Stimulation of the cerebral cortex in the intact human subject, Nature, 285, (1980)
[3]  
Rothwell J.C., Thompson P.D., Day B.L., Et al., Stimulation of the human motor cortex through the scalp, Exp Physiol, 76, pp. 159-200, (1991)
[4]  
Edmonds H.L., Paloheimo M.P.I., Backman M.H., Et al., Transcranial magnetic motor evoked potentials (tc MMEP) for functional monitoring of motor pathways during scoliosis surgery, Spine, 14, pp. 683-686, (1989)
[5]  
Jones S.J., Harrison R., Koh K.F., Et al., Motor evoked potential monitoring during spinal surgery: Responses of distal limb muscles to transcranial cortical stimulation with pulse trains, Electroencephalogr Clin Neurophysiol, 100, pp. 375-383, (1996)
[6]  
Pechstein U., Cedzich C., Nadstawek J., Et al., Transcranial high-frequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia, Neurosurgery, 39, pp. 335-343, (1996)
[7]  
Burke D., Hicks R., Stephen J., Et al., Assessment of corticospinal and somatosensory conduction simultaneously during scoliosis surgery, Electroencephalogr Clin Neurophysiol, 85, pp. 388-396, (1992)
[8]  
Kombos T., Suess O., Ciklatekerlio O., Brock M., Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex, 95, pp. 608-614, (2001)
[9]  
Morota N., Deletis V., Constantini S., Et al., The role of motor evoked potentials during surgery for intramedullary spinal cord tumors, Neurosurgery, 41, pp. 1327-1336, (1997)
[10]  
Yang L.H., Lin S.M., Lee W.Y., Et al., Intraoperative transcranial electrical motor evoked potentials monitoring during spinal surgery under intravenous ketamine or etomidate anesthesia, Acta Neurochir, 127, pp. 191-198, (1994)