Wu Tian,Wu Shuihua.Intraoperative neurophysiological monitoring for complex lipoma-type spinal cord embolism in children[J].Journal of Clinical Pediatric Surgery,2025,(06):553-558.[doi:10.3760/cma.j.cn101785-202410051-009]
神经电生理监测在儿童复杂脊髓脂肪瘤手术中的应用
- Title:
- Intraoperative neurophysiological monitoring for complex lipoma-type spinal cord embolism in children
- Keywords:
- Neurophysiological Monitoring; Lipoma; Spinal Cord; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨神经电生理监测在儿童复杂脊髓脂肪瘤手术中的应用价值。方法 回顾性分析2019年1月至2024年4月中南大学湘雅医学院附属儿童医院(湖南省儿童医院)收治的29例复杂脊髓脂肪瘤患儿临床资料,其中男13例、女16例,中位年龄9个月(范围:2个月至9岁3个月),＜3岁14例、≥3岁15例。背侧型1例,过渡型20例,混杂型8例。术中神经电生理监测内容包括运动诱发电位(motion evoked potential,MEP)、躯体感觉诱发电位(somatosensory evoked potential,SEP)、自由肌电图(free-run electromyography,EMG)及诱发肌电(triggered-EMG)。观察患儿术后1 d双下肢肌力以及术后6个月双下肢肌力、大小便和脊髓脂肪瘤切除情况。结果 29例均在神经电生理监测下完成手术。14例年龄＜3岁的患儿中,SEP基线建立4例,MEP基线建立8例,2例基线未建立。15例年龄≥3岁的患儿中,SEP基线建立12例,MEP基线建立15例。术中电生理预警情况:SEP预警2例次,MEP预警8例次,EMG预警32例次。29例中,实现全切及近全切23例,部分切除6例。术后第1天,23例下肢肌力正常;6例下肢肌力下降新发/加重,予康复治疗(术后6个月,4例下肢肌力恢复至正常,2例下肢肌力持续下降)。术后6个月,无一例大小便功能障碍新发或加重,4例术前存在小便功能障碍的患儿中,2例无改善,2例恢复正常;3例术前存在大便功能障碍患儿中,1例无改善,2例恢复正常。结论 神经电生理监测技术能够实时监测并指导儿童复杂脊髓脂肪瘤手术进程,有效降低术中神经损伤风险,在儿童复杂脊髓脂肪瘤手术中具有重要的临床意义。
- Abstract:
- Objective To explore the significance of intraoperative electrophysiological monitoring for children with complex lipomatous tethered cord syndrome (C-LTCS). Methods From January 2019 to April 2024,the relevant clinical data were retrospectively reviewed for 29 children hospitalized with complex spinal cord lipomas.There were 13 boys and 16 girls with a median age of 9(2-111) month.The range was <3 year (n=14) and ≥3 year (n=15).The clinical types were dorsal (n=1),transitional (n=20) and mixed (n=8).Intraoperative neurophysiological monitoring included motion evoked potential (MEP),somatosensory evoked potential (SEP),free-run electromyography (EMG) and triggered-EMG at Day 1 post-operation.Muscle strength of bilateral lower limbs,urination and defecation were recorded. Results All operations were completed under neurophysiological monitoring.Among 14 children aged <3 year,SEP baseline was established (n=4),MEP baseline established (n=8) and the rest not established.Among 15 children aged ≥3 year,baseline was established (n=12),MEP baseline established (n=15) and the rest not established.Total/near-total resection (n=23) and partial resection (n=6) were achieved.Frequency of intraoperative electrophysiological warnings was SEP (n=2),MEP (n=8) and EMG (n=32).Total and near-total resection (n=23) and partial resection (n=6) were performed.On Day 1 post-operation,lower limb muscle strength was normal (n=23) and lower limb muscle strength decline was new/exacerbated (n=6).After 6-month rehabilitation,lower limb muscle strength normalized (n=4) and lower limb muscle strength declined (n=2).At Month 6 post-operation,none of them had a new onset or an aggravation of urinary and fecal dysfunction.Among 4 children with preoperative urinary dysfunction,2 cases had no improvement and 2 cases normalized;among the 3 children with preoperative fecal dysfunction,1 case had no improvement and 2 cases normalized. Conclusions Neurophysiological monitoring technology may monitor and guide surgical process of complex spinal cord lipoma in real time and effectively lower the risk of intraoperative nerve injury in children.Its application for complex spinal cord lipoma surgery has important clinical significance.
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备注/Memo
收稿日期:2024-10-22。
基金项目:湖南省中医药科研课题(C2024022)
通讯作者:吴水华,Email:292454021@qq.com