Wang Yongqiang,Wang Hangzhou,Han Yong,et al.Application of intraoperative neuroelectrophysiological monitoring during operations for pediatric brainstem glioma[J].Journal of Clinical Pediatric Surgery,,21():941-946.[doi:10.3760/cma.j.cn101785-202204053-008]
Application of intraoperative neuroelectrophysiological monitoring during operations for pediatric brainstem glioma
- Keywords:
- Neurophysiological Monitoring; Brain Stem Glioma; Neurosurgical Procedures; Treatment Outcome; Child
- Abstract:
- Objective To explore the application of intraoperative neuroelectrophysiological monitoring during operations for pediatric brainstem glioma.Methods From January 2016 to September 2021,clinical data were retrospectively reviewed for 18 children with brainstem glioma undergoing operations with intraoperative neuroelectrophysiological monitoring.The age range was 1 to 14 years.The contents of intraoperative monitoring included mapping,somatosensory evoked potential (SSEP),motor evoked potential (MEP),brainstem auditory evoked potential (BAEP) and electromyography (EMG).Perioperative complications were recorded during a follow-up period of 0.5-6 years.And the changes of tumor imaging and neurological functions were analyzed.Results No perioperative mortality occurred in this series.Deteriorating lateral limb function was observed in 2 cases after operation which recovered to preoperative level with the help of rehabilitation treatment 1 month later.At one month follow-up study before radiation therapy or chemotherapy,average Karnofsky performance score was 86.11±9.79 which was significantly higher (t=3.96,P<0.01) than that before surgery 73.89±21.46.Conclusion Intraoperative neuroelectrophysiological monitoring is both feasible and stable for operations of pediatric brainstem glioma.It can effectively enhance surgical safety and improve long-term prognosis.
References:
[1] Kwon JW,Kim IO,Cheon JE,et al.Paediatric brain-stem gliomas:MRI,FDG-PET and histological grading correlation[J].Pediatr Radiol,2006,36(9):959-964.DOI:10.1007/s00247-006-0256-5.
[2] 葛明,杨伟,李少武,等.儿童脑干胶质瘤的临床特点及预后分析[J].中华神经外科杂志,2021,37(7):679-683.DOI:10.3760/cma.j.cn112050-20200706-00381.Ge M,Yang W,Li SW,et al.Clinical features and surgical outcomes in children with brain stem glioma[J].Chinese Journal of Neurosurgery,2021,37(7):679-683.DOI:10.3760/cma.j.cn112050-20200706-00381.
[3] 毛颖,蔡加君,姚瑜.脑干胶质瘤的现状及展望[J].中华神经外科疾病研究杂志,2015,14(2):97-100.Mao Y,Cai JJ,Yao Y.Present status and future prospects of brainstem glioma[J].Chin J Neurosurg Dis Res,2015,14(2):97-100.
[4] Choux M,Di Rocco C,Hockley A,ed al.Pediatric Neurosurgery[M].New York:Churchill Livingstone,2000,471-491.
[5] 王勇强,陈民,王杭州.肌电图监测在儿童脊髓栓系松解术中的应用[J].临床小儿外科杂志,2018,17(12):922-926.DOI:10.3969/j.issn.1671-6353.2018.12.010.Wang YQ,Chen M,Wang HZ.Application of electromyogram monitoring during spinal cord loosening for tethered cord syndrome in children[J].J Clin Ped Sur,2018,17(12):922-926.DOI:10.3969/j.issn.1671-6353.2018.12.010.
[6] 王俊华,张玉琪,陈拓宇,等.儿童脑干胶质瘤的临床诊治及预后分析[J].中华神经外科杂志,2021,37(7):684-689.DOI:10.3760/cma.j.cn112050-20200620-00362.Wang JH,Zhang YQ,Chen TY,et al.Clinical diagnosis,treatment and prognosis of brainstem glioma in children[J].Chin J Neurosurg,2021,37(7):684-689.DOI:10.3760/cma.j.cn112050-20200620-00362.
[7] 中华医学会神经外科学分会肿瘤学组,脑干胶质瘤综合诊疗中国专家共识编写委员会.脑干胶质瘤综合诊疗中国专家共识[J].中华神经外科杂志,2017,33(3):217-229.DOI:10.3760/cma.j.issn.1001-2346.2017.03.001.Group of Oncology,Society of Neurosurgery,Chinese Medical Association.Chinese Expert Consensus on Comprehensive Diagnosis and Treatment of Brainstem Glioma[J].Chinese Journal of Neurosurgery,2017,33(3):217-229.DOI:10.3760/cma.j.issn.1001-2346.2017.03.001.
[8] Liu Z,Feng S,Li J,et al.The epidemiological characteristics and prognostic factors of low-grade brainstem glioma:a real-world study of pediatric and adult patients[J].Front Oncol,2020,10:391.DOI:10.3389/fonc.2020.00391.
[9] Green AL,Kieran MW.Pediatric brainstem gliomas:new understanding leads to potential new treatments for two very different tumors[J].Curr Oncol Rep,2015,17(3):436.DOI:10.1007/s11912-014-0436-7.
[10] Fisher PG,Breiter SN,Carson BS,et al.A clinicopathologic reappraisal of brain stem tumor classification.Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities[J].Cancer,2000,89(7):1569-1576.DOI:10.1002/1097-0142(20001001)89:7<1569::aid-cncr22>3.0.co;2-0.
[11] 孙涛,刘玉含,泮长存,等.多模态技术辅助手术切除儿童局灶型脑干胶质瘤[J].中华神经外科杂志,2017,33(12):1204-1208.DOI:10.3760/cma.j.issn.1001-2346.2017.12.004.Sun T,Liu YH,Pan CC,ed al.Surgical treatment of localized brainstem gliomas in children with multimodality techniques[J].Chin J Neurosurg,2017,33(12):1204-1208.DOI:10.3760/cma.j.issn.1001-2346.2017.12.004.
[12] Deletis V,Fernández-Conejero I.Intraoperative monitoring and mapping of the functional integrity of the brainstem[J].J Clin Neurol,2016,12(3):262-273.DOI:10.3988/jcn.2016.12.3.262.
[13] 中国医师协会神经外科分会神经电生理监测专家委员会.中国神经外科术中电生理监测规范(2017版)[J].中华医学杂志,2018,98(17):1283-1293.DOI:10.3760/cma.j.issn.0376-2491.2018.17.002.Neurophysiological Monitoring Expert Committee,Neurosurgery Branch of Chinese Medical Doctor Association.Chinese Specifications for intraoperative Electrophysiological Monitoring in Neurosurgery (2017 Edition)[J].National Medical Journal of China,2018,98(17):1283-1293.DOI:10.3760/cma.j.issn.0376-2491.2018.17.002.
[14] Prell J,Rampp S,Romst?ck J,et al.Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma[J].J Neurosurg,2007,106(5):826-832.DOI:10.3171/jns.2007.106.5.826.
[15] Prell J,Strauss C,Rachinger J,et al.The intermedius nerve as a confounding variable for monitoring of the free-running electromyogram[J].Clin Neurophysiol,2015,126(9):1833-1839.DOI:10.1016/j.clinph.2014.11.028.
[16] 姜伊昆,钱俊,张磊,等.术中神经电生理监测在颅底外科中的应用进展[J].现代生物医学进展,2014,14(34):6755-6757,6761.DOI:10.13241/j.cnki.pmb.2014.34.040.Jiang YK,Qian J,Zhang L,et al.Application advances of intraoperative neurophysiological monitoring during skull base surgery[J].Progress in Modern Biomedicine,2014,14(34):6755-6757,6761.DOI:10.13241/j.cnki.pmb.2014.34.040.
[17] Gentili F,Lougheed WM,Yamashiro K,et al.Monitoring of sensory evoked potentials during surgery of skull base tumours[J].Can J Neurol Sci,1985,12(4):336-340.DOI:10.1017/s0317167100035484.
[18] Sarnthein J,Bozinov O,Melone AG,et al.Motor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function[J].Acta Neurochir (Wien),2011,153(9):1753-1759.DOI:10.1007/s00701-011-1065-7.
[19] Kombos T,Kopetsch O,Suess O,et al.Does preoperative paresis influence intraoperative monitoring of the motor cortex?[J].J Clin Neurophysiol,2003,20(2):129-134.DOI:10.1097/00004691-200304000-00007.
[20] MacDonald DB.Overview on criteria for MEP monitoring[J].J Clin Neurophysiol,2017,34(1):4-11.DOI:10.1097/WNP.0000000000000302.
[21] 陶晓蓉,王明然,王荣,等.术中直接电刺激运动诱发电位对脑干运动功能保护作用初探[J].中国现代神经疾病杂志,2020,20(11):949-954.DOI:10.3969/j.issn.1672-6731.2020.11.004.Tao XR,Wang MR,Wang R,et al.Preliminary study on protective effect of intraoperative direct electrical stimulation motor-evoked potential on brainstem motor function[J].Chinese Journal of Contemporary Neurology and Neurosurgery,2020,20(11):949-954.DOI:10.3969/j.issn.1672-6731.2020.11.004.
[22] Prabhu SS,Gasco J,Tummala S,et al.Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors.Clinical article[J].J Neurosurg,2011,114(3):719-726.DOI:10.3171/2010.9.JNS10481.
[23] Deletis V,Urriza J,Ulkatan S,et al.The feasibility of recording blink reflexes under general anesthesia[J].Muscle Nerve,2009,39(5):642-646.DOI:10.1002/mus.21257.
Memo
收稿日期:2022-4-15。
基金项目:苏州市姑苏卫生人才计划(GSWS2020051)
通讯作者:王杭州,Email:wanghangzhoudr@126.com