미세혈관 감압술중 뇌간청각유발전위 감시장치의 유용성

Significance of Intraoperative BAEPs Monitoring during Microvascular Decompression Surgery

  • 김태준 (한양대학교 의과대학 신경외과학교실) ;
  • 고용 (한양대학교 의과대학 신경외과학교실) ;
  • 김영수 (한양대학교 의과대학 신경외과학교실) ;
  • 오성훈 (한양대학교 의과대학 신경외과학교실) ;
  • 김광명 (한양대학교 의과대학 신경외과학교실) ;
  • ;
  • 오석전 (한양대학교 의과대학 신경외과학교실)
  • Kim, Tae Joon (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Ko, Yong (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Kim, Young Soo (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Oh, Seong Hoon (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Kim, Kwang Myung (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Kim, Nam Kyu (Department of Neurosurgery, Hanyang University, School of Medicine) ;
  • Oh, Suck Jun (Department of Neurosurgery, Hanyang University, School of Medicine)
  • 투고 : 1999.07.12
  • 심사 : 2000.01.27
  • 발행 : 2000.05.28

초록

Objective : Surgery for the microvascular decompression is mostly concerned with injury to the cranial nerves or brain stem by cerebellar retraction. Intraopeartive brain stem auditory evoked potentials(BAEPs) has been continuously monitored on surgery to evaluate the extent of injury, recovery of the nerves and prognosis. Methods : Of the 161 cases of CP angle surgery from Feb. 1996 to Apr. 1998, 103 cases were monitored during operation. Thirty five patients who had undergone similar surgery were selected and evaluated ; 23 patients were monitored and 12 were not during surgery. If monitor showed more than 0.5 mSec delay of latency, surgeon was given a warning not to retract brain any more. If more than 1mSec delay, surgeon was informed to stop surgery and wait for the returning of evoked potentials. The level of amplitudes and delay of latencies during the initial stage of operation, opening the dura, insertion of teflon patches, and closing the dura and recovery were then compared. Resuls : Twenty patients were male and 15 were female. Their average age was 50.26 years. Mean amplitude during the initial stage of operation was $0.60{\pm}0.25mV$, at opening the dura $0.56{\pm}0.26$, after teflon patches insertion $0.49{\pm}0.20$, and after closure of dura $0.47{\pm}0.28mV$. Mean latency during the early stage of operation was $6.08{\pm}0.67mSec$, at opening of dura $6.38{\pm}0.55$, insertion of teflon $6.97{\pm}0.59$, and closing the dura $6.17{\pm}0.54$. There was statistical significance in the difference of amplitudes between each procedures, and in the difference of latencies. For the complete recovery of amplitude and latency, it usually took average 5.65 minutes(0-20 min). In monitored group, only one patient required more than 20 minutes to recover and suffered from hearing disturbance after surgery. Others were recovered within 10 minutes without complications. However, 4 out of 12 patients who were not monitored showed hearing disturbance, and 1 patient had temporary facial palsy and dizziness(p=0.000). Conclusion : The results indicate that continuous intraoperative monitoring of BAEPs during CP angle surgery is seen mandatory procedure to prevent operative complications.

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