臨床検査66巻7号

2022年07月発行

今月の特集 臨床検査技師によるタスク・シフト/シェア 臨床検査技師に追加される業務の実際と注意点

運動誘発電位モニタリング・体性感覚誘発電位モニタリング

著者： 安藤宗治¹

所属機関： ¹関西医科大学整形外科学講座

ページ範囲：P.868 - P.876

Point

●術後神経合併症の生じる危険性が高い脊椎脊髄手術においては術中神経生理学的モニタリング（IONM）の施行が必須である．

●運動路の監視には経頭蓋刺激・運動誘発電位（Tc-MEP）が用いられ，連発刺激を加えて末梢の筋から複合筋活動電位を記録する．

●感覚路の監視には体性感覚誘発電位（SEP）が用いられ，末梢神経を刺激して頭皮上から誘発電位を記録する．

●Tc-MEPは吸入麻酔で電位が低下するため全静脈麻酔を用いることが多い．一方，SEPの大脳皮質第一次感覚野の電位は吸入麻酔で低下するが，脳幹由来の電位は低下しにくい．

参考文献

1）Imajo Y, Taguchi T, Yone K, et al：Japanese 2011 nationwide survey on complications from spine surgery. J Orthop Sci　20：38-54，2015

2）Matsumoto M, Toyama Y, Chikuda H, et al：Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine: a multicenter retrospective survey: clinical article. J Neurosurg Spine　15：380-385，2011

3）Matsuyama Y, Sakai Y, Katayama Y, et al：Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection. J Neurosurg Spine　10：404-413，2009

4）Kondo M, Matsuda H, Miyawaki Y, et al:：A new method of electrodiagnosis during operations on the brachial plexus and peripheral nerve injuries. The value of motor nerve action potentials evoked by trans-skull motor area stimulation. Int Orthop　9：115-121，1985

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

6）Ando M, Tamaki T, Yoshida M, et al：Intraoperative spinal cord monitoring using combined motor and sensory evoked potentials recorded from the spinal cord during surgery for intramedullary spinal cord tumor. Clin Neurol Neurosurg　133：18-23，2015

7）Kobayashi K, Ando K, Nakashima H, et al：Poor derivation of Tc-MEP baseline waveforms in surgery for ventral thoracic intradural extramedullary tumor: Efficacy of use of the abductor hallucis in cases with a preoperative non-ambulatory status. J Clin Neurosci　84：60-65，2021

8）Macdonald DB, Skinner S, Shils J, et al：Intraoperative motor evoked potential monitoring - a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol　124：2291-2316，2013

9）Ugawa R, Takigawa T, Shimomiya H, et al：An evaluation of anesthetic fade in motor evoked potential monitoring in spinal deformity surgeries. J Orthop Surg Res　13：227，2018

10）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

11）Tanaka M, Shigematsu H, Kawaguchi M, et al：Muscle-evoked Potentials After Electrical Stimulation to the Brain in Patients Undergoing Spinal Surgery are Less Affected by Anesthetic Fade With Constant-voltage Stimulation Than With Constant-current Stimulation. Spine （Phila Pa 1976）　44：1492-1498，2019

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 （Phila Pa 1976）　33：E994-E1000，2008

13）Costa P, Peretta P, Faccani G：Relevance of intraoperative D wave in spine and spinal cord surgeries. Eur Spine J　22：840-848，2013

14）Ando M, Tamaki T, Maio K, et al：The muscle evoked potential after epidural electrical stimulation of the spinal cord as a monitor for the corticospinal tract: studies by collision technique and double train stimulation. J Clin Monit Comput Jun 28. Online ahead of print，2021

15）Yoshida G, Imagama S, Kawabata S, et al：Adverse Events Related to Transcranial Electric Stimulation for Motor-evoked Potential Monitoring in High-risk Spinal Surgery. Spine （Phila Pa 1976）　44：1435-1440，2019

16）Langeloo DD, Lelivelt A, Louis Journée H, 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

17）Kobayashi S, Matsuyama Y, Shinomiya K, et al：A new alarm point of transcranial electrical stimulation motor evoked potentials for intraoperative spinal cord monitoring: a prospective multicenter study from the Spinal Cord Monitoring Working Group of the Japanese Society for Spine Surgery and Related Research. J Neurosurg Spine　20：102-107，2014

18）Toleikis JR：Intraoperative monitoring using somatosensory evoked potentials. A position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput　19：241-258，2005