Desflurane麻酔下頸椎症性脊髄症手術におけるMEP導出不良リスクとしてのT2髄内高信号
頸椎症性脊髄症手術において筋力が保たれているにも関わらずMEPが導出困難な症例に遭遇する。MRI T2強調像における髄内高信号 (increased signal intensity, ISI) との関連性を検討した。対象は下肢標的筋がMMT 4以上かつNurick scale 4以下の, desfluraneで麻酔管理を行った61例。ISI (−) 群は32例, ISI (+) 群は29例であった。傾向スコア分析で年齢, Nurick scale, JOA scoreを共変量としてcase matchを行い, 22ペアを抽出した。波形導出が両下肢ともに困難であった症例をbaseline ME...
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| Published in | 臨床神経生理学 Vol. 48; no. 6; pp. 633 - 638 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床神経生理学会
01.12.2020
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| Online Access | Get full text |
| ISSN | 1345-7101 2188-031X |
| DOI | 10.11422/jscn.48.633 |
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| Abstract | 頸椎症性脊髄症手術において筋力が保たれているにも関わらずMEPが導出困難な症例に遭遇する。MRI T2強調像における髄内高信号 (increased signal intensity, ISI) との関連性を検討した。対象は下肢標的筋がMMT 4以上かつNurick scale 4以下の, desfluraneで麻酔管理を行った61例。ISI (−) 群は32例, ISI (+) 群は29例であった。傾向スコア分析で年齢, Nurick scale, JOA scoreを共変量としてcase matchを行い, 22ペアを抽出した。波形導出が両下肢ともに困難であった症例をbaseline MEP failureと定義し, 各群におけるbaseline MEP failureの発生率を比較した。ISI (+) 群で有意にfailureが多く, ISIを認める場合はMEP導出不良に備える必要がある。 |
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| AbstractList | 頸椎症性脊髄症手術において筋力が保たれているにも関わらずMEPが導出困難な症例に遭遇する。MRI T2強調像における髄内高信号 (increased signal intensity, ISI) との関連性を検討した。対象は下肢標的筋がMMT 4以上かつNurick scale 4以下の, desfluraneで麻酔管理を行った61例。ISI (−) 群は32例, ISI (+) 群は29例であった。傾向スコア分析で年齢, Nurick scale, JOA scoreを共変量としてcase matchを行い, 22ペアを抽出した。波形導出が両下肢ともに困難であった症例をbaseline MEP failureと定義し, 各群におけるbaseline MEP failureの発生率を比較した。ISI (+) 群で有意にfailureが多く, ISIを認める場合はMEP導出不良に備える必要がある。 |
| Author | 池田, 紘二 大西, 英之 松岡, 龍太 久我, 純弘 山本, 慎司 |
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| References | 6) Mizuno J, Nakagawa H, Inoue T, et al: Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord. J Neurosurg 99: 162–168, 2003. 7) Taniguchi M, Cedzich C, Schramm J: Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery 32: 219–226, 1993. 11) Tsutsui S, Iwasaki H, Yamada H, et al: Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery. J Clin Monit Comput 29: 35–39, 2015. 2) Chen X, Sterio D, Ming X, et al: Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24: 281–285, 2007. 8) Kurokawa R, Kim P, Itoki K, et al: False-positive and false-negative results of motor evoked potential monitoring during surgery for intramedullary spinal cord tumors. Operative Neurosurgery 14: 279–287, 2018. 12) Hayashi H, Kawaguchi M, Yamamoto Y, et al: Evaluation of reliability of post-tetanic motor-evoked potential monitoring during spinal surgery under general anesthesia. Spine 33: E994–E1000, 2008. 10) Lo YL, Dan YF, Tan YE, et al: Intraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens. J Neurosurg Anesthesiol 18: 211–214, 2006. 1) Sala F, Palandri G, Basso E, et al: Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58: 1129–1143; discussion 1129-1143, 2006. 9) Lawrence DG, Kuypers HG: Pyramidal and non-pyramidal pathways in monkeys: anatomical and functional correlation. Science 148: 973–975, 1965. 5) Bucciero A, Vizioli L, Carangelo B, et al: MR signal enhancement in cervical spondylotic myelopathy. Correlation with surgical results in 35 cases. J Neurosurg Sci 37: 217–222, 1993. 3) Rajshekhar V, Velayutham P, Joseph M, et al: Factors predicting the feasibility of monitoring lower-limb muscle motor evoked potentials in patients undergoing excision of spinal cord tumors. J Neurosurg Spine 14: 748–753, 2011. 4) Kim J-S, Jang M-J, Hyun S-J, et al: Failure to generate baseline muscle motor evoked potentials during spine surgery: Risk factors and association with the postoperative outcomes. Clin Neurophysiol 129: 2276–2283, 2018. |
| References_xml | – reference: 6) Mizuno J, Nakagawa H, Inoue T, et al: Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord. J Neurosurg 99: 162–168, 2003. – reference: 2) Chen X, Sterio D, Ming X, et al: Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring: effects of age, lesion location, and preoperative neurologic deficits. J Clin Neurophysiol 24: 281–285, 2007. – reference: 3) Rajshekhar V, Velayutham P, Joseph M, et al: Factors predicting the feasibility of monitoring lower-limb muscle motor evoked potentials in patients undergoing excision of spinal cord tumors. J Neurosurg Spine 14: 748–753, 2011. – reference: 4) Kim J-S, Jang M-J, Hyun S-J, et al: Failure to generate baseline muscle motor evoked potentials during spine surgery: Risk factors and association with the postoperative outcomes. Clin Neurophysiol 129: 2276–2283, 2018. – reference: 5) Bucciero A, Vizioli L, Carangelo B, et al: MR signal enhancement in cervical spondylotic myelopathy. Correlation with surgical results in 35 cases. J Neurosurg Sci 37: 217–222, 1993. – reference: 1) Sala F, Palandri G, Basso E, et al: Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58: 1129–1143; discussion 1129-1143, 2006. – reference: 8) Kurokawa R, Kim P, Itoki K, et al: False-positive and false-negative results of motor evoked potential monitoring during surgery for intramedullary spinal cord tumors. Operative Neurosurgery 14: 279–287, 2018. – reference: 11) Tsutsui S, Iwasaki H, Yamada H, et al: Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery. J Clin Monit Comput 29: 35–39, 2015. – reference: 7) Taniguchi M, Cedzich C, Schramm J: Modification of cortical stimulation for motor evoked potentials under general anesthesia: technical description. Neurosurgery 32: 219–226, 1993. – reference: 12) Hayashi H, Kawaguchi M, Yamamoto Y, et al: Evaluation of reliability of post-tetanic motor-evoked potential monitoring during spinal surgery under general anesthesia. Spine 33: E994–E1000, 2008. – reference: 9) Lawrence DG, Kuypers HG: Pyramidal and non-pyramidal pathways in monkeys: anatomical and functional correlation. Science 148: 973–975, 1965. – reference: 10) Lo YL, Dan YF, Tan YE, et al: Intraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens. J Neurosurg Anesthesiol 18: 211–214, 2006. |
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| Title | Desflurane麻酔下頸椎症性脊髄症手術におけるMEP導出不良リスクとしてのT2髄内高信号 |
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