目的总结多模态术中神经电生理监测技术在Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)相关周围神经肿瘤手术中的应用效果及临床经验。方法回顾性分析2019年1月—2023年12月接受多模态术中神经电生理监测下周围神经肿瘤切除手术的94...目的总结多模态术中神经电生理监测技术在Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)相关周围神经肿瘤手术中的应用效果及临床经验。方法回顾性分析2019年1月—2023年12月接受多模态术中神经电生理监测下周围神经肿瘤切除手术的94例NF1患者临床资料。男49例,女45例;年龄5~78岁,平均33.7岁。肿瘤形态学分型:结节型71例,弥漫型13例,混合型10例。手术目标肿瘤分布区域:颅面部47例,颈部11例,躯干12例,四肢24例。术前44例无明显神经系统相关症状;其余患者存在神经系统相关症状,包括视力障碍15例、听力障碍5例、躯体运动障碍16例、躯体感觉障碍31例,其中7例同时存在1项以上症状。肿瘤切除术中根据目标肿瘤侵犯区域的相关神经及毗邻重要结构,选择相应的术中神经电生理监测方案,包括视觉诱发电位(17例)、体感诱发电位(44例)、运动诱发电位(88例)、肌电图(94例)监测。结果94例患者均顺利完成手术;除1例患者接受姑息性切除外,其余93例均按术前计划行全/近全切除目标肿瘤。病理检查示神经纤维瘤80例,恶性周围神经鞘瘤14例。术后发生术区血肿2例、切口感染3例,无其他严重并发症发生。患者均获随访,随访时间3~61个月,中位时间15个月。随访期间均未发现明显神经症状改变或肿瘤复发。术前视力障碍患者术后14例无改善,1例改善。躯体运动障碍者术后11例症状无改善、3例减轻、2例加重,新增4例,1例自觉明显影响生活。躯体感觉障碍者术后17例症状无改善、14例减轻,新增13例。听力障碍者术后均较术前改善。结论NF1相关周围神经肿瘤临床表现复杂多样。多模态术中神经电生理监测技术能实时反映神经受激惹/损伤程度,采用其辅助肿瘤切除安全性高,相关并发症较少。展开更多
Objective: To establish an objective criterion for assessing brain tolerance to carotid artery occlusion. Methods Endovascular trial balloon occlusion of carotid artery (TBO) in combination with single-photon emission...Objective: To establish an objective criterion for assessing brain tolerance to carotid artery occlusion. Methods Endovascular trial balloon occlusion of carotid artery (TBO) in combination with single-photon emission computed tomography (SPECT), transcranial Doppler ultrasonography (TCD) and carotid artery stump pressure (SP) measurement was performed routinely for those patients who might have carotid artery manipulated or permanently occluded. Results Out of the 10 cases, one failed the TBO, though an angiographically adequate collateral circulation was observed. The patient’s SP and relative symmetry (rS) of SPECT imaging were 51mmHg and 86%. The remaining cases showed negative TBOs. After carotid occlusions, their mean velocity of ipsilateral middle cerebral artery decreased (16. 3 ± 6. 9 )%. The mean rS was (98. 0 ± 2. 4)% (92. 7% -101. 3% ). The mean SP was (64. 5 ± 13. 0)mmHg [(72. 3±11. 3)% of baseline, range 32-83mmHg. For one subject, the ICA was occluded spontaneously in the test. A reversal internal carotid artery (ICA ) flow was noted in 3 patients with balloon inflated in the common carotid artery (CCA ). When the CCA was occluded, the system blood pressure and heart rate increased apparently. However, this phenomenon did not occur when the ballon was inflated in the ICA. Conclusion With this TBO technique, clinically silent areas of decreased perfusion might be detected. We suggest it be a routine examination prior to carotid manipulations.展开更多
文摘目的总结多模态术中神经电生理监测技术在Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)相关周围神经肿瘤手术中的应用效果及临床经验。方法回顾性分析2019年1月—2023年12月接受多模态术中神经电生理监测下周围神经肿瘤切除手术的94例NF1患者临床资料。男49例,女45例;年龄5~78岁,平均33.7岁。肿瘤形态学分型:结节型71例,弥漫型13例,混合型10例。手术目标肿瘤分布区域:颅面部47例,颈部11例,躯干12例,四肢24例。术前44例无明显神经系统相关症状;其余患者存在神经系统相关症状,包括视力障碍15例、听力障碍5例、躯体运动障碍16例、躯体感觉障碍31例,其中7例同时存在1项以上症状。肿瘤切除术中根据目标肿瘤侵犯区域的相关神经及毗邻重要结构,选择相应的术中神经电生理监测方案,包括视觉诱发电位(17例)、体感诱发电位(44例)、运动诱发电位(88例)、肌电图(94例)监测。结果94例患者均顺利完成手术;除1例患者接受姑息性切除外,其余93例均按术前计划行全/近全切除目标肿瘤。病理检查示神经纤维瘤80例,恶性周围神经鞘瘤14例。术后发生术区血肿2例、切口感染3例,无其他严重并发症发生。患者均获随访,随访时间3~61个月,中位时间15个月。随访期间均未发现明显神经症状改变或肿瘤复发。术前视力障碍患者术后14例无改善,1例改善。躯体运动障碍者术后11例症状无改善、3例减轻、2例加重,新增4例,1例自觉明显影响生活。躯体感觉障碍者术后17例症状无改善、14例减轻,新增13例。听力障碍者术后均较术前改善。结论NF1相关周围神经肿瘤临床表现复杂多样。多模态术中神经电生理监测技术能实时反映神经受激惹/损伤程度,采用其辅助肿瘤切除安全性高,相关并发症较少。
文摘Objective: To establish an objective criterion for assessing brain tolerance to carotid artery occlusion. Methods Endovascular trial balloon occlusion of carotid artery (TBO) in combination with single-photon emission computed tomography (SPECT), transcranial Doppler ultrasonography (TCD) and carotid artery stump pressure (SP) measurement was performed routinely for those patients who might have carotid artery manipulated or permanently occluded. Results Out of the 10 cases, one failed the TBO, though an angiographically adequate collateral circulation was observed. The patient’s SP and relative symmetry (rS) of SPECT imaging were 51mmHg and 86%. The remaining cases showed negative TBOs. After carotid occlusions, their mean velocity of ipsilateral middle cerebral artery decreased (16. 3 ± 6. 9 )%. The mean rS was (98. 0 ± 2. 4)% (92. 7% -101. 3% ). The mean SP was (64. 5 ± 13. 0)mmHg [(72. 3±11. 3)% of baseline, range 32-83mmHg. For one subject, the ICA was occluded spontaneously in the test. A reversal internal carotid artery (ICA ) flow was noted in 3 patients with balloon inflated in the common carotid artery (CCA ). When the CCA was occluded, the system blood pressure and heart rate increased apparently. However, this phenomenon did not occur when the ballon was inflated in the ICA. Conclusion With this TBO technique, clinically silent areas of decreased perfusion might be detected. We suggest it be a routine examination prior to carotid manipulations.
