neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2022-24-3-73-79neurosurgery-1243Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWИнтраоперационный нейрофизиологический мониторинг в хирургии опухолей головного мозга супратенториальной локализации. Часть 2. Исследование сенсорной проводимости, влияние на исходы и ограничения методаIntraoperative neuromonitoring in surgery of supratentorial brain tumors. Part 2. Assessment of sensory conductivity, impact at outcomes and method restrictionshttps://orcid.org/0000-0002-7635-9701ДмитриевА. Ю.DmitrievA. Yu.

Дмитриев Александр Юрьевич.

129090 Москва, Большая Сухаревская пл., 3; 127473 Москва, ул. Делегатская, 20, стр. 1.

Aleksandr Yu. Dmitriev.

3 Bolshaya Sukharevskaya Sq., Moscow 129090; Bld. 1, 20 Delegatskaya St., Moscow 127473.

dmitriev@neurosklif.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.

129090 Москва, Большая Сухаревская пл., 3; 127473 Москва, ул. Делегатская, 20, стр. 1.

3 Bolshaya Sukharevskaya Sq., Moscow 129090; Bld. 1, 20 Delegatskaya St., Moscow 127473.

https://orcid.org/0000-0002-5847-9435ДашьянВ. Г.DashyanV. G.

129090 Москва, Большая Сухаревская пл., 3; 127473 Москва, ул. Делегатская, 20, стр. 1.

3 Bolshaya Sukharevskaya Sq., Moscow 129090; Bld. 1, 20 Delegatskaya St., Moscow 127473.

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А. И. Евдокимова» Минздрава РоссииРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaRussian Federation2022051020222437379Copyright © Дмитриев А.Ю., Синкин М.В., Дашьян В.Г., 20222022Дмитриев А.Ю., Синкин М.В., Дашьян В.Г.Dmitriev A.Y., Sinkin M.V., Dashyan V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1243

Введение. Среди методов оценки чувствительного проведения при интраоперационном нейромониторинге в хирургии супратенториальных опухолей наиболее часто применяют фазово-реверсивные соматосенсорные вызванные потенциалы, чтобы определить локализацию центральной борозды. Уникальность метода заключается в возможности его применения у больных с грубым парезом перед операцией; чувствительность достигает 97 %, но снижается при расположении опухоли в роландовой борозде.  При мониторировании зрительных вызванных потенциалов оценивают целостность зрительных проводящих путей, что актуально при новообразованиях затылочной и задних отделов височных долей. Информативность зрительных вызванных потенциалов достигает 94 %. В отличие от картирования зрительных проводящих путей данный метод более объективен, так как не основан на субъективных ощущениях пациента и может применяться у больных в наркозе.  Применение интраоперационного нейромониторинга в 2-5 раз повышает радикальность резекций опухолей функционально значимых зон головного мозга и в 2 раза снижает количество стойких неврологических нарушений после операции.  Точность интраоперационного нейромониторинга снижается при ревизионных операциях и ишемическом повреждении головного мозга вследствие ангиоспазма. Для сохранения высокой прогностической значимости метода количество мониторируемых мышц должно быть обратно пропорционально плотности проводящих путей в зоне операции. 

Among methods of assessment of sensory conductivity of neuromonitoring in surgery of supratentorial tumors somatosensory evoked potential phase reversal are used most commonly to identify location of central sulcus. Method's uniqueness lies in possibility of its usage in patients with severe paresis before operation. Its sensitivity reaches 97 % but decreases with tumor location in Rolandic area.

In monitoring of visual evoked potentials integrity of visual pathways are estimated, that is actually in lesions of occipital and posterior temporal lobes. Accuracy of visual evoked potentials reaches 94 %. In contrast to mapping of visual pathways method is more unbiassed because is not founded on subjective patient's feelings and can be applied in general anesthesia.

Neuromonitoring's usage increases extent of eloquent tumor resection in 2 to 5 times and decreases the number of permanent neurological deficit in 2 times after surgery.

Accuracy of neuromonitoring decreases in reoperations and in ischemic damage due to angiospasm. To maintain high predictive value of the method amount of monitoring muscles should be inverse proportionally to the density of subcortical pathways in area of resection.

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The authors declare that there are no conflicts of interest present.