頭蓋底外科手術の神経モニタリング

Intraoperative Neuromonitoring for Skull Base Surgery

Point

・頭蓋底部の手術，とりわけ腫瘍の摘出術では，各種脳神経モニタリング法のセットアップおよびデータの解釈を適切に行い運用することが重要である．

・顔面神経機能をはじめとした運動神経のモニタリング法として，運動誘発電位（MEP）の記録が有用である．

・脳神経に直接アプローチする場合は神経マッピングと持続モニタリングの意義を見極め，筋電図free-runningの観察も含めて，用途に応じ適宜併用した運用を行う．

　Intraoperative neuromonitoring techniques can be used to evaluate neural functions during surgical procedures. For removal of tumors in the skull base region, we perform them for both structural mapping of the compressed cranial nerves and continuous monitoring of their preservation. The goal is to eliminate the critical irreversible damage to the neurological structures and prevent postoperative neurologic deficits. Recording techniques have been developed and neuromonitoring equipment used in the operation room with the intravenous anesthesia technique. For skull base surgery, in particular, the neuromonitoring contains motor evoked potential（MEP）, brainstem auditory evoked potential（BAEP）, visual evoked potential（VEP）, and others. We believe that the appropriate recording and interpretation of these data can greatly improve the surgical outcomes of tumor removal and prevent postoperative neurologic deficits.