Journal of New Medical Technologies Journal of New Medical Technologies Вестник новых медицинских технологий 1609-2163 5082 10.12737/9087 Обзоры литературы Literature Reviews Обзоры литературы Ntra-Operative Neurophysiological Monitoring During the Removal of Intramedullary Tumors (literary review) Интраоперационный нейрофизиологический мониторниг при удалении интрамедуллярных опухолей (литературный обзор) Федин П. А. Fedin P. А. Шахпаронова Н. В. Shakhparonova N. В. Гуща А. О. Gushcha A. О. Буркова Е. А. Burkova E. А. Нейматов Э. М. Neymatov E. М. 13 03 2015 13 03 2015 22 1 93 101 https://zh-szf.ru/en/nauka/article/5082/view

В связи с увеличивающимся прогрессом в области нейрохирургии и возможностью тотального удаления большинства интрамедуллярных опухолей, встает вопрос о максимальной сохранности функций спинного мозга. С изобретением и активным внедрением нейрофизиологического интраоперационного мониторинга становится возможным в режиме реального времени оценивать влияние хирургических манипуляций на проводящие пути спинного мозга. Эффективное и обоснованное проведение мониторинга включает оценку как двигательных, так и чувствительных путей для получения полной информации о функциях спинного мозга. Выявление предикторов благоприятного функционального исхода и разработка алгоритма проведения мониторинга позволяет модифицировать нейрохирургическую тактику и улучшить качество жизни пациента после операции. В статье описаны все методы интраоперационного мониторинга и рассмотрены физиологические факторы, оказывающие влияние на мониторинг ответов. Приведены данные о воздействии различных анестетиков на способность нейронов проводить импульсы, и рассмотрены комбинации наиболее благоприятных комбинаций препаратов. Доказано, что данные интраоперационного мониторинга эффективны в качестве предикторов высокого риска послеоперационных осложнений (4 исследования класса I и 7 исследований класса II). Необходимо учитывать, что такие факторы как опыт нейрофизиолога и его умение интерпретировать данные, а также опыт хирурга в использовании этих данных, действия анестезиолога – весь процесс взаимодействия влияет на конечный исход операции.

Progress in the field of neurosurgery and the possibility of total removal of the majority of intramedullary tumors leads to the question about maximum security functions of the spinal cord. The invention and implementation of intra-operative neuro-physiological monitoring (IOM) provides real-time to assess the impact of surgical procedures on the pathways of the spinal cord. Effective and informed monitoring includes an assessment of motor and sensitive ways to complete information about the functions of the spinal cord. Identifying predictors of favorable functional outcome and algorithm development monitoring allows the authors to modify neurosurgical tactics and improve the patient´s quality of life after surgery. This article describes all the methods IOM and physiological factors affecting the monitoring of responses. The authors review data on the effects of different anesthetics on the ability of neurons to conduct impulses and the most favorable combinations of drugs. It is proved that the IOM is effective as predictors of high risk of postoperative complications (4 studies class I and 7 studies of class II). It is important to consider the factors such as experience neurophysiologist and his ability to interpret data, as well as experience of the surgeon in using these data, the actions of the anesthesiologist - the whole process of interaction affects the final outcome of the operation.

интрамедуллярная опухоль интраоперационный нейрофизиологический мониторинг соматосенсорные вызванные потенциалы моторные вызванные потенциалы intramedullary spinal cord tumors intra-operative neuro-physiological monitoring somatosensory evoked potentials motor evoked potent

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