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首页> 外文期刊>Neurosurgery >The predictive value of intraoperative somatosensory evoked potential monitoring: review of 244 procedures.
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The predictive value of intraoperative somatosensory evoked potential monitoring: review of 244 procedures.

机译：术中体感诱发电位监测的预测价值：审查244例程序。

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INTRODUCTION: There is some controversy regarding the value of intraoperative neurophysiological monitoring in predicting postoperative neurological deficits. We discuss our experience with the use of intraoperative somatosensory evoked potentials (SSEPs) during surgery of cranial base tumors. METHODS: We retrospectively reviewed all of the procedures that had been performed for the resection of cranial base tumors from July 29, 1993, through March 16, 1995. One hundred ninety-three consecutive patients had undergone a total of 244 procedures. SSEP waveforms were classified as follows: Type I, no change; Type II, change that reverts to baseline; Type III, change that does not revert to baseline; and Type IV, complete flattening of the SSEP waveform without improvement. Two patients had no waveforms from the beginning of the case (Type V) and were excluded from further analysis. New immediate postoperative neurological deficits were recorded. RESULTS: There were 64 male and 129 female patients, with a mean age of 46.6 years. One hundred seventy-seven patients had Type I SSEP waveforms, 13 of whom had postoperative deficits (7%). Fifty-six patients had Type II SSEPs, and nine (16%) of them had postoperative neurological deficits. Six patients had Type III SSEPs, and three had Type IV SSEPs, all of whom (100%) had postoperative deficits. There was a correlation between SSEP type and the results of the postoperative neurological examinations. The positive predictive value is 100%, and the negative predictive value is 90%. Although a change in the waveform that did not revert to baseline (Types III and IV) always predicted a postoperative deficit, a normal waveform did not always rule out postoperative deficits. Pathological abnormality, vessel encasement, vessel narrowing, degree of cavernous sinus involvement, brain stem edema, middle fossa location, final amount of resection, age, and tumor size correlated with a high predictive value of SSEP monitoring on univariate analysis (P < 0.05). None of these variables correlated significantly on multivariate analysis (P > 0.05), although brain stem edema was close (P = 0.0571). CONCLUSION: Intraoperative SSEPs have a high positive predictive value during surgery for cranial base tumors, but they do not detect all postoperative deficits.
机译：简介：术中神经生理学监测在预测术后神经功能缺损中的价值存在争议。我们讨论在颅底肿瘤手术中使用术中体感诱发电位（SSEP）的经验。方法：我们回顾性回顾了1993年7月29日至1995年3月16日切除颅底肿瘤的所有手术方法。193例连续患者共接受了244例手术。 SSEP波形分类如下：I型，无变化;类型II，恢复为基线的更改;类型III，不恢复为基线的更改;和IV型，SSEP波形完全变平而没有改善。两名患者从病例开始就没有波形（V型），因此被排除在进一步分析之外。记录了新的术后立即神经功能缺损。结果：男64例，女129例，平均年龄46.6岁。 177例患者具有I型SSEP波形，其中13例具有术后缺陷（7％）。五十六名患者患有II型SSEP，其中九名（16％）患有术后神经功能缺损。 6例患有III型SSEP，3例患有IV型SSEP，所有这些患者（100％）都有术后缺陷。 SSEP类型与术后神经系统检查结果之间存在相关性。阳性预测值为100％，阴性预测值为90％。尽管没有恢复到基线的波形变化（III型和IV型）总是预示着术后缺陷，但正常波形并不总是排除术后缺陷。病理异常，血管包裹，血管狭窄，海绵窦受累程度，脑干水肿，中窝窝位置，最终切除量，年龄和肿瘤大小与单因素分析中SSEP监测的高预测价值相关（P <0.05） 。尽管脑干水肿接近（P = 0.0571），但这些变量在多变量分析中均无显着相关性（P> 0.05）。结论：术中SSEP对颅底肿瘤在手术中具有较高的阳性预测价值，但不能检测出所有术后缺陷。

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