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Brain and Nerve No to Shinkei Volume 40, Issue 3 （March 1988）

Brain and Nerve 脳と神経 40巻3号（1988年3月発行）

Japanese English

原著

正中神経刺激による体性感覚誘発電位の大脳皮質上および皮質下記録について CORTICAL AND SUBCORTICAL SOMATOSENSORY EVOKED POTENTIALS TO MEDIAN NERVE STIMULATION IN MAN 高橋宏 ¹ , 安江正治 ² , 鈴木一郎 ² , 石島武一 ² Hiroshi Takahashi ¹ , Masaharu Yasue ² , Ichiro Suzuki ² , Buichi Ishijima ² ¹東京都立神経病院脳神経外科 ²現籍：東京慈恵会医科大学脳神経外科 ¹Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital pp.275-283

発行日 1988年3月1日 Published Date 1988/3/1

DOI https://doi.org/10.11477/mf.1406206076

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Abstract 文献概要
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　抄録　開頭手術を安全に行う目的で，19症例において，術中大脳皮質上より対側の正中神経刺激によるSEPを記録し，前・後中心回等の同定を行った。さらに，3例の広範囲減圧開頭施行症例の骨欠損部より多チャンネルのSEPを記録し，二次元脳電図で分析した。又，前頭葉皮質下電極を刺入する機会のあった4例で，皮質下SEPを記録した。皮質上記録では，頭頂葉よりN19（平均頂点潜時19.4±1,2ms），P 22（22.5±2.2ms），P23（23.7±3.0ms）が得られ，前頭葉よりP20（20.1±1.2ms），N25（25.1±3.2ms）が観察された。N19とP20との間の極性逆転現象により中心溝位置は容易に確認でき，手術に際し有用であった。各波の分布では，P20／N25は前頭葉皮質上広く出現し，N19／P23も頭頂葉上広汎に記録された。P22は，後中心回の比較的狭い領域において認められ，手の感覚野を反映するものと考えられた。皮質下記録では，P20が両側前頭葉皮質下より広く認められ，皮質上下での極性逆転は認められなかった。以上の結果からN19, P 20は，中心溝後壁に生じたhorizontal dipoleにより形成され，　P 22は，後中心回のvertical dipoleを反映するものと考察した。

In order to define the precise locations of pre-central and postcentral gyri during neurosurgicaloperations, somatosensory evoked potentials to contralateral median nerve stimulation were re-corded from the cerebral cortex in 19 cases with organic cerebral lesions which located near the central sulcus.

In addition to that, distribution patterns of early components of SEPs were displayed by Nihonkoden Atac 450 in 3 cases who had bone defects after wide decompressive craniectomy but were without any sensory disturbances

In 4 cases, in whom deep electrodes were in-serted for the streotaxic operations or other rea-sons, frontal subcortical SEPs were recorded in order to know the origins of frontal components of SEPs.

From the parietal cortex, N 19, P 22 and P 23 were observed. And from the frontal cortex, P 20 and N 25 were obtained. Their average peak la-tencies were as follows;

N 19…19.4±1.2 ms. P22…22.5±2.2ms.

P 23…23.7±3.0 ms. P 20…20.1±1.2 ms.

N 25…25.1±3.2 ms.

Because all subjects had organic lesion in the brain, the peak latencies were a little bit longer, and their standard deviations were larger than those in normal cases.

Usually, clear-cut phase reversal could be ob-served between N 19 and P 20 across the central sulcus. So, the precentral and postcentral gyri were easily identified during the operations. N 19 and P 23 appeared over the wide areas of the parietal cortex. Also, P 20 and N 25 were recorded almost whole areas of the frontal cortex. On the other hand, P 22 appeared from relatively restrict-ed part of the postcentral gyrus where sensory hand area might have been located.

Depth recording from the frontal subcortical area revealed that P 20 could be recorded from the bilateral frontal subcortical areas and there observed no phase reversal between the cortical and subcortical SEPs.

These results indicate that N 19 from the parietal and P 20 from the frontal cortex may be generated by the horizontal dipole located at the posterior bank of the central sulcus and that distribution pattern of P 20 can be compatible with that of far field potential like N 16. While, P 22 is thought to be originated by the vertical dipole at the crown of the postcentral gyrus.