目的 探讨脊髓髓内肿瘤切除手术中采用神经电生理监测对手术效果及患者预后的影响。 方法 回顾首都医科大学附属北京积水潭医院2018年1月至2020年12月显微手术切除治疗的脊髓髓内肿瘤患者92例，其中48例采用传统显微手术（对照组），44例采用神经电生理监测下显微手术（联合组），对比两组肿瘤切除率、手术前后脊髓功能、临床症状改善及3年随访情况。 结果 肿瘤完全切除率联合组与对照组无统计学差异（P>0.05）；手术前，联合组和对照组患者感觉功能障碍、运动功能障碍、疼痛发生率及括约肌功能障碍发生率无统计学差异（P>0.05）；联合组患者术后6月感觉功能障碍发生率、术后3月运动功能障碍发生率均显著低于对照组（P<0.05）；手术前，联合组和对照组患者脊髓功能McCormick分级构成无统计学差异（P>0.05）；术后6月联合组患者脊髓McCormick分级优于对照组（P<0.05）；术后3年肿瘤复发率，联合组6.82%，对照组12.50%，两组无统计学差异（P>0.05）。 结论 脊髓髓内肿瘤切除手术中采用神经电生理监测更有利于减轻手术引起的脊髓损伤，促进术后患者的运动及感觉功能恢复及脊髓功能恢复，但是对患者的远期预后影响不大。
Abstract
Objective To explore the impact of using neurophysiological monitoring during spinal cord intramedullary tumor resection surgery on surgical outcomes and patient prognosis. Methods A retrospective study was conducted on 92 patients with spinal cord intramedullary tumors who underwent microsurgical resection treatment at Beijing Jishuitan Hospital affiliated to Capital Medical University from January 2018 to December 2020. Among them, 48 patients received traditional microsurgical resection treatment (control group), while the other 44 patients received microsurgical resection treatment + neurophysiological monitoring (combination group). The surgical resection effects, spinal cord function evaluation at different times before and after surgery, clinical symptoms and postoperative occurrence at 3 years were compared between the two groups. Results There was no statistical difference in total tumor resection rate between the combined group and control group (P>0.05). Before surgery, there was no statistical difference in the incidence of sensory dysfunction, motor dysfunction, pain and sphincter dysfunction between the combination group and the control group (P>0.05). The incidence of sensory dysfunction and motor dysfunction in combined group patients at 6 months and 3 months after surgery were significantly lower than those in control group (P<0.05). Before surgery, there was no statistical difference in the composition of the McCormick grading of spinal cord function between combination group and control group (P>0.05). After 6 months of postoperative evaluation, the McCormick grading of spinal cord in combination group was better than that in the control group (P<0.05). After a 3-year follow-up, the recurrence rate in combination group was 6.82%, while the recurrence rate in control group was 12.50%. There was no statistical difference in the recurrence rate between two groups (P>0.05). Conclusions The use of neurophysiological monitoring during spinal cord intramedullary tumor resection surgery is more conducive to reducing spinal cord injury caused by surgery, promoting postoperative recovery of motor and sensory functions and spinal cord function in patients, but it has little impact on the prognosis of patients.
关键词
脊髓； /
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髓内肿瘤； /
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显微镜手术； /
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神经电生理监测； /
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预后
Key words
Spinal cord; /
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Intramedullary tumors; /
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Microscopic surgery; /
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Neuroelectrophysiological monitoring; /
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Prognosis
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参考文献
[1] Decharin P, Suvithayasiri S, Nivatpumin P, et al. Subpial schwannoma of the cervical spinal cord: a case report and its intraoperative finding supporting a theory of the pathogenesis of an intramedullary schwannoma[J]. Asian J Neurosurg, 2022,17(1):108-111. DOI: 10.1055/s-0042-1748785.
[2] Gazzeri R, Telera S, Galarza M, et al. Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications-a multicenter study[J]. Neurosurg Rev, 2021, 44(6): 3267-3275. DOI: 10.1007/s10143-021-01491-8.
[3] Shanthanna H, Uppal V, Joshi GP, et al. Intraoperative nociception monitoring[J]. Anesthesiol Clin, 2021, 39(3): 493-506. DOI: 10.1016/j.anclin.2021.03.008.
[4] Rajappa D, Khan MM, Masapu D, et al. Multimodal intraoperative neurophysiological monitoring in spine surgeries: the experience at a spine centre through years[J]. Asian Spine J, 2021, 15(6): 728-738. DOI: 10.31616/asj.2020.0400.
[5] 史玉泉, 周孝达. 实用神经病学[M]. 上海: 上海科学技术出版社, 2004: 88-89.
[6] Wang H, Zhang L, Wang H, et al. Spinal hemangioblastoma: surgical procedures, outcomes and review of the literature[J]. Acta Neurol Belg, 2021, 121(4): 973-981. DOI: 10.1007/s13760-020-01420-4.
[7] Sánchez Roldán MÁ, Moncho D, Rahnama K, et al. Intraoperative neurophysiological monitoring in syringomyelia surgery: a multimodal approach[J]. J Clin Med,2023,12(16):5200.DOI: 10.3390/jcm12165200.
[8] Miró Lladó J, López-Ojeda P, Pedro J, et al. Evaluation of multimodal intraoperative neurophysiologic monitoring during supratentorial aneurysm surgery: a comparative study[J]. Neurosurg Rev, 2022, 45(3): 2161-2173. DOI: 10.1007/s10143-021-01710-2.
[9] Gupta S, Siddiqui SA, Sinha U, et al. Multimodal intraoperative neurophysiological monitoring in cranial and spinal tumour surgeries: a descriptive observational study[J]. Cureus, 2023, 15(11): e49411. DOI: 10.7759/cureus.49411.
[10] Tropeano MP, Rossini Z, Franzini A, et al. Multimodal intraoperative neurophysiological monitoring in intramedullary spinal cord tumors: a 10-year single center experience[J]. Cancers (Basel), 2023, 16(1): 111. DOI: 10.3390/cancers16010111.
[11] Agarwal N, Shabani S, Huang J, et al. Intraoperative monitoring for spinal surgery[J]. Neurol Clin, 2022, 40(2): 269-281. DOI: 10.1016/j.ncl.2021.11.006.
[12] Sangeetha RP, Bharadwaj S. KetaDex: a saviour for intraoperative multimodal neurophysiological monitoring in complex neurosurgeries[J]. Neurol India, 2021, 69(1): 187-189. DOI: 10.4103/0028-3886. 310078.
[13]Siller S, Sixta A, Tonn JC, et al. Feasibility of multimodal intraoperative neurophysiological monitoring for extramedullary spinal cord tumor surgery in elderly patients[J]. Acta Neurochir (Wien), 2023, 165(8): 2089-2099. DOI: 10.1007/s00701-023-05682-8.
[14] Li Q, Gu G, Wang L, et al. Using EMG signals to assess proximity of instruments to nerve roots during robot-assisted spinal surgery[J]. Int J Med Robot, 2022, 18(4): e2408. DOI: 10.1002/rcs.2408.
[15] Bianchi F, Cursi M, Caravati H, et al. Intraoperative neurophysiologic monitoring in thoracoabdominal aortic aneurysm surgery can provide real-time feedback for strategic decision making[J]. Neurophysiol Clin, 2022, 52(3): 232-241. DOI: 10.1016/j.neucli.2021.12.006.
[16] Li R, Huang ZC, Cui HY, et al. Utility of somatosensory and motor-evoked potentials in reflecting gross and fine motor functions after unilateral cervical spinal cord contusion injury[J]. Neural Regen Res, 2021, 16(7): 1323-1330. DOI: 10.4103/1673-5374.301486.
[17] Antkowiak L, Putz M, Sordyl R, et al. Relevance of intraoperative motor evoked potentials and D-wave monitoring for the resection of intramedullary spinal cord tumors in children[J]. Neurosurg Rev, 2022, 45(4): 2723-2731. DOI: 10.1007/s10143-022-01788-2.
基金
国家自然科学基金项目(61271367)；北京积水潭医院高层次人才“学科骨干”培养计划项目(XKGG202115)
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