Neurological Surgery 脳神経外科51巻3号

2023年05月発行

特集 Theモニタリング—基本から応用まで Ⅱ モニタリング種類別

運動誘発電位（MEP）

著者： 田中聡¹

所属機関： ¹沼田脳神経外科循環器科病院脳神経外科

ページ範囲：P.398 - P.407

Point
・運動誘発電位（MEP）モニタリングの刺激方法は，運動野皮質直接刺激法と経頭蓋刺激法がある．導出は最近ではほとんど筋電図導出が用いられている．
・MEPの評価方法には，閾値法と振幅評価法がある．アラームポイントやカットオフポイントを設定するためには，振幅評価が一般的となる．
・MEPで術後不可逆的な麻痺を生じる閾値，すなわち，カットオフポイントは約70〜80%の振幅低下であると考えられる．

参考文献

1）Morota N, et al：The role of motor evoked potentials during surgery for intramedullary spinal cord tumors. Neurosurgery 41：1327-1336, 1997

2）Szelényi A, et al：Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report. J Neurosurg 99：575-578, 2003

3）Burke D, Hicks RG：Surgical monitoring of motor pathways. J Clin Neurophysiol 15：194-205, 1998

4）Kombos T, et al：Does preoperative paresis influence intraoperative monitoring of the motor cortex? J Clin Neurophysiol 20：129-134, 2003

5）Kaneko M, et al：Intraoperative monitoring of the motor function：experimental and clinical study. Acta Neurochir Suppl（Wien）42：18-21, 1988

6）Levy WJ Jr：Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20：169-182, 1987

7）岩崎素之，他：術中MEPモニタリングが有用であった内頚動脈瘤の1例．脳神外ジャーナル 17：622-626, 2008

8）MacDonald DB：Safety of intraoperative transcranial electrical stimulation motor-evoked potential monitoring. J Clin Neurophysiol 19：416-429, 2002

9）Rothwell J, et al：Transcranial electrical stimulation of the motor cortex in man：further evidence for the site of activation. J Physiol 481（Pt 1）：243-250, 1994

10）Zhou HH, Kelly PJ：Transcranial electrical motor evoked potential monitoring for brain tumor resection. Neurosurgery 48：1075-1080；discussion 1080-1081, 2001

11）Yamamoto T, et al：Intraoperative monitoring of the corticospinal motor evoked potential（D-wave）：clinical index for postoperative motor function and functional recovery. Neurol Med Chir（Tokyo）44：170-180；discussion 181-182, 2004

12）Suzuki K, et al：Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg 98：507-514, 2003

13）Smith I, et al：Propofol. An update on its clinical use. Anesthesiology 81：1005-1043, 1994

14）Taniguchi M, et al：Modification of cortical stimulation for motor evoked potentials under general anesthesia：technical description. Neurosurgery 32：219-226, 1993

15）Yamaguchi F, et al：An intraoperative motor tract positioning method in brain tumor surgery：technical note. J Neurosurg 129：576-582, 2018

16）Quiñones-Hinojosa A, et al：Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function. Neurosurgery 56：982-993；discussion 982-993, 2005

17）山本隆充，他：大脳皮質運動領の直接刺激法と経頭蓋刺激法による下降性脊髄誘発電位の比較．臨脳波 40：162-166, 1998

18）高梨淳子，田中　聡：脳神経外科術中モニタリングとしての経頭蓋高電圧MEPの有用性．臨神生 32：4-11, 2004

19）Tanaka S, et al：Sensitivity and specificity in transcranial motor-evoked potential monitoring during neurosurgical operations. Surg Neurol Int 2：111, 2011　doi：10.4103/2152-7806.83731

20）Chin KR, et al：“White cord syndrome” of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression：a case report. Case Rep Orthop 2013：697918, 2013　doi：10.1155/2013/697918

21）Tanaka S, et al：Compensation of intraoperative transcranial motor-evoked potential monitoring by compound muscle action potential after peripheral nerve stimulation. J Clin Neurophysiol 22：271-274, 2005

22）Tanaka S, et al：Cutoff points, sensitivities, and specificities of intraoperative motor-evoked potential monitoring determined using receiver operating characteristic analysis. J Neurol Surg A Cent Eur Neurosurg 80：102-108, 2019

23）Tanaka S, et al：Intraoperative monitoring during decompression of the spinal cord and spinal nerves using transcranial motor-evoked potentials：the law of twenty percent. J Clin Neurosci 22：1403-1407, 2015

24）Tanaka S, et al：Effect of compound muscle action potential after peripheral nerve stimulation normalization on anesthetic fade of intraoperative transcranial motor-evoked potential. J Clin Neurophysiol 38：306-311, 2021

25）Metz CE, et al：Evaluation of receiver operating characteristic curve data in terms of information theory, with applications in radiography. Radiology 109：297-303, 1973

26）Langeloo DD, et al：Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity：a study of 145 patients. Spine（Phila Pa 1976）28：1043-1050, 2003

27）小林　祥，他：振幅70%をアラームポイントとした術中脊髄モニタリング—多施設前向き研究．J Spine Res 3：438, 2012

28）Lyon R, et al：Progressive suppression of motor evoked potentials during general anesthesia：the phenomenon of “anesthetic fade”. J Neurosurg Anesthesiol 17：13-19, 2005

29）Kakinohana M, et al：Propofol reduces spinal motor neuron excitability in humans. Anesth Analg 94：1586-1588, 2002

30）Matsuoka R, et al：A case of concomitant lip injury and facial pressure ulcer in lumbar intradural tumor surgery with repeated transcranial electrical stimulations. Cureus 14：e31560, 2022　doi：10.7759/cureus.31560

31）Shoakazemi A, et al：Necrotizing fasciitis：a life-threatening complication of intraoperative electromyography. Cureus 8：e468, 2016　doi：10.7759/cureus.468

32）Toleikis JR, et al：The usefulness of electrical stimulation for assessing pedicle screw placements. J Spinal Disord 13：283-289, 2000