这项研究的目的是比较在同一患者队列中手术期间经颅电刺激(TES)后运动诱发电位(MEPs)监测的新阈值和幅度标准之间的敏感性和特异性。
纳入了126名患者。所有手术均在全身麻醉下进行。开颅手术没有暴露运动皮层,所以直接映射不太合适。TES之后,MEP的双侧记录来自短腿外展人(APB),来自口轮匝肌(OO),和/或来自胫骨前肌(TA)。评估阈值水平的百分比增加,并且如果在受影响侧超过未受影响侧的百分比增加20%以上,则认为是显著的。在受影响侧的振幅测量为每个肌肉设定的阈值水平的150%的刺激强度。
126例患者中有18例显示出阈值水平的显着变化以及从APB记录的MEP中振幅降低超过50%,15例患者术后手臂运动功能恶化(8例暂时性,7例永久性[真阳性和假阴性结果])。对66例患者进行了TA记录;4例发生了腿部运动功能的术后恶化(3例暂时性,1例永久性),并显示出阈值水平的显着变化,1例患者的振幅减少超过50%。另外10名患者的振幅减少超过50%,阈值水平无明显变化或术后恶化。对61例患者进行了OO记录;3例发生术后面部肌肉运动功能恶化(2例暂时性,1例永久性),阈值水平发生显着变化,2例患者的振幅降低超过50%。另有6例患者的振幅降低超过50%,但阈值水平或术后恶化没有显着变化。当从APB记录MEP时,阈值标准的灵敏度为100%,OO,或者TA,其特异性为97%,100%,100%,分别。振幅判据的灵敏度为100%,67%,25%,特异性为97%,90%,84%,分别。
当记录来自APB的MEP时,在灵敏度和特异性方面,阈值标准与刺激强度设置为阈值水平的150%的振幅标准相当,从TA或OO录制时优于它。
The aim of this study was to compare sensitivity and specificity between the novel threshold and amplitude criteria for motor evoked potentials (MEPs) monitoring after transcranial electrical stimulation (TES) during surgery for supratentorial lesions in the same patient cohort.
One hundred twenty-six patients were included. All procedures were performed under general anesthesia. Craniotomies did not expose motor cortex, so that direct mapping was less suitable. After TES, MEPs were recorded bilaterally from abductor pollicis brevis (APB), from orbicularis oris (OO), and/or from tibialis anterior (TA). The percentage increase in the threshold level was assessed and considered significant if it exceeded by more than 20% on the affected side the percentage increase on the unaffected side. Amplitude on the affected side was measured with a stimulus intensity of 150% of the threshold level set for each muscle.
Eighteen of 126 patients showed a significant change in the threshold level as well as an amplitude reduction of more than 50% in MEPs recorded from APB, and 15 of the patients had postoperative deterioration of motor function of the arm (temporary in 8 cases and permanent in 7 [true-positive and false-negative results]). Recording from TA was performed in 66 patients; 4 developed postoperative deterioration of motor function of the leg (temporary in 3 cases and permanent in 1), and showed a significant change in the threshold level, and an amplitude reduction of more than 50% occurred in 1 patient. An amplitude reduction of more than 50% occurred in another 10 patients, without a significant change in the threshold level or postoperative deterioration. Recording from OO was performed in 61 patients; 3 developed postoperative deterioration of motor function of facial muscles (temporary in 2 cases and permanent in 1) and had a significant change in the threshold level, and 2 of the patients had an amplitude reduction of more than 50%. Another 6 patients had an amplitude reduction of more than 50% but no significant change in the threshold level or postoperative deterioration.Sensitivity of the threshold criterion was 100% when MEPs were recorded from APB, OO, or TA, and its specificity was 97%, 100%, and 100%, respectively. Sensitivity of the amplitude criterion was 100%, 67%, and 25%, with a specificity of 97%, 90%, and 84%, respectively.
The threshold criterion was comparable to the amplitude criterion with a stimulus intensity set at 150% of the threshold level regarding sensitivity and specificity when recording MEPs from APB, and superior to it when recording from TA or OO.