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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Kim, Keewon (Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine) Cho, Charles (Department of Neurology, Stanford University) Bang, Moon-suk (Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine) Shin, Hyung-ik (Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine) Phi, Ji-Hoon (Department of Neurology, Stanford University) Kim, Seung-Ki (Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제61권 제3호
발행연도
2018.1
수록면
363 - 375 (13page)

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Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.
#Monitoring #Intraoperative #Brain neoplasm #Neurosurgery #Child

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참고문헌 (78)

참고문헌 신청
Anderson S / 1990 / A technique for monitoring evoked potentials during scoliosis and brachial plexus surgery / Ann R Coll Surg Engl 72:321~323 google schola Angel A / 1982 / The effect of anaesthetic agents on cerebral cortical responses in the rat / Br J Pharmacol 76:541~549 Crossref Brell M / 2000 / Factors influencing surgical complications of intra-axial brain tumours / Acta Neurochir (Wien) 142:739~750 Crossref Burke D / 1992 / Assessment of corticospinal and somatosensoty conduction simultaneously during scoliosis surgery / Electroencephalogr Clin Neurophysiol 85:388~396 Crossref Calancie B / 1998 / "Threshold-level" multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring / J Neurosurg 88:457~470 Crossref

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