並列タイトル等頚椎手術術中神経モニタリングにおける偽陽性減少を目的とした顔面運動誘発電位の応用
タイトル（掲載誌）Journal of neurosurgery. Spine
一般注記type:Thesis
Objective: False-positive intraoperative muscle motor evoked potential (mMEP) monitoring results due to systemic effects of anesthetics and physiological changes continue to be a challenging issue. Although control MEPs recorded from the unaffected side are useful for identifying a true-positive signal, there are no muscles on the upper or lower extremities to induce control MEPs in cervical spine surgery. Therefore, this study was conducted to clarify if additional MEPs derived from facial muscles can feasibly serve as controls to reduce false-positive mMEP monitoring results in cervical spine surgery. Methods: Patients who underwent cervical spine surgery at the authors' institution who did not experience postoperative neurological deterioration were retrospectively studied. mMEPs were induced with transcranial supramaximal stimulation. Facial MEPs (fMEPs) were subsequently induced with suprathreshold stimulation. The mMEP and subsequently recorded fMEP waveforms were paired during each moment during surgery. The initial pair was regarded as the baseline. A significant decline in mMEP and fMEP amplitude was defined as > 80% and > 50% decline compared with baseline, respectively. All mMEP alarms were considered false positives. Based on 2 different alarm criteria, either mMEP alone or both mMEP and fMEP, rates of false-positive mMEP monitoring results were calculated. Results: Twenty-three patients were included in this study, corresponding to 102 pairs of mMEPs and fMEPs. This included 23 initial and 79 subsequent pairs. Based on the alarm criterion of mMEP alone, 17 false-positive results (21.5%) were observed. Based on the alarm criterion of both mMEP and fMEP, 5 false-positive results (6.3%) were observed, which was significantly different compared to mMEP alone (difference 15.2%; 95% CI 7.2%-23.1%; p < 0.01). Conclusions: fMEPs might be used as controls to reduce false-positive mMEP monitoring results in cervical spine surgery.
博士（医学）・甲第746号・令和2年6月30日
© Copyright 2019 American Association of Neurological Surgeons
The definitive version is available at " http://dx.doi.org/10.3171/2019.9.SPINE19800 "
identifier:Journal of neurosurgery. Spine Vol.32 No.4 p.570-577 (2019 Dec)
identifier:15475654
identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3753
identifier:Journal of neurosurgery. Spine, 32(4): 570-577
DOIinfo:doi/10.3171/2019.9.SPINE19800
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