使用带动态气球的电极术中监测皮质脊髓束完整性的技术

V. V. Krylov, V. A. Lukianchikov, V. A. Gorozhanin, Z. Barbakadze, M. Sinkin
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引用次数: 0

摘要

目的介绍一种使用带动态气球的电极连续监测皮质脊髓束完整性的技术,研究选定监测技术和替代监测技术的优缺点。在第一阶段,制备了一个与动态气球相结合的电极。第二阶段,在大脑手术的主要阶段使用球囊网格直接刺激大脑皮层,对皮质脊髓束进行连续监测。在第三阶段,对获得的神经电生理反应进行解释。所介绍的通过使用所开发的设备直接刺激大脑皮层连续监测皮质脊髓束完整性的技术可防止错误反应的减少,这大大有助于解释所获得的结果并提高该技术的信息价值。所描述的技术基于对脑内肿瘤切除术的临床观察,以及使用该技术进行的显微外科动脉瘤夹闭术。在手术过程中,由于动态球囊充气和电极与大脑表面保持紧密接触,没有观察到神经电生理信号振幅的错误下降。使用该技术进行的手术使患者在术后获得了良好的神经功能。该设备可在任何脑回缩水平使用条状电极直接刺激大脑皮层,进行连续神经监测。该技术降低了皮质脊髓束和皮质球束的原发性和继发性损伤风险,从而提高了神经外科干预的安全性,降低了神经系统并发症的风险。
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Technique for intraoperative monitoring of corticospinal tract integrity using an electrode with a dynamic balloon
Aim. To present a technique for continuous monitoring of corticospinal tract integrity using an electrode with a dynamic balloon, examine the advantages and disadvantages of the selected and alternative monitoring techniques.Materials and methods. At the 1st stage, an electrode combined with a dynamic balloon was prepared. At the 2nd stage, continuous monitoring of the corticospinal tract using direct stimulation of the cortex using ballon grid during the main stage of cerebral surgery was performed. At the 3rd stage, interpretation of the obtained neurophysiological responses was performed.Results. The presented technique of continuous monitoring of the integrity of the corticospinal tract through direct cortical stimulation using the developed device prevents false response decreases which significantly helps with the interpretation of the obtained results and increases information value of the technique. The described technique is based on the presented clinical observations of intracerebral tumor resection, as well as microsurgical aneurysm clipping using the technique. During surgery, no false decrease of the neurophysiological signal amplitude was observed due to dynamic ballon inflation and maintenance of close contact between the electrode and the surface of the brain. A surgery performed using this technique allowed to achieve a favorable neurological outcome in a patient in the postoperative period.Conclusion. The presented device allows to perform continuous neuromonitoring using direct cortical electrostimulation with a strip electrode at any level of brain retraction. The technique decreases the risk of primary and secondary injury of the corticospinal and corticobulbar tracts which increases safety of neurosurgical intervention and decreases risks of neurological complications.
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