Analysis Of Influence Factors Of HF-SCS Technology On Limb Motor Function In Patients With Motor Functional Area Glioma After Operation

Objective:To investigate the influence factors of the application of high frequency monopole subcortical electrical stimulation(HF-SCS)technology on the short-term and long-term limb movement ability of patients with motor functional area glioma after surgery,to summarize the technical methods for reducing intraoperative motor nerve injury,and to provide clinical basis and reference for improving the postoperative quality of life of patients.Methods:A total of 41 patients who met the inclusion and exclusion criteria and were diagnosed as motor function area glioma in the Department of Neurosurgical Oncology of the First Hospital of Jilin University from June2021 to October 2022 were included.All patients received Transcranial electrical stimulation motor-evoked potentials(TES-MEPs)and high frequency monopole subcortical electrical stimulation(HF-SCS)technology during the operation.Basic clinical data,preoperative imaging data,intraoperative electrophysiological report results,surgical records and physical examination on the first day after surgery were collected,and outpatient review or telephone follow-up of patients were conducted three months after surgery.SPSS26.0 analysis software was applied to Chi-square analysis,T-test analysis,Mann-Whitney U rank sum test,and binary regression logistic analysis.This study analyzed the correlation between patients’ age,gender,history of hypertension,history of diabetes,tumor location,operation duration,DTI results,tumor pathological grade,whether the amplitude of TES-MEPs decreased by more than 50% during surgery,intensity threshold of high frequency monopole subcortical electrical stimulation(HF-SCS)and short-term and long-term postoperative limb muscle strength.Results:A total of 41 sample patients were enrolled in this study,including 25males(60.98%)and 16 females(39.02%).Eleven patients(26.83%)had a history of hypertension;7 patients(17.07%)had a history of diabetes;Nineteen patients(46.34%)had tumors in the left hemisphere and 22(53.66%)in the right hemisphere.DTI indicated compression or interruption of CST in 20patients(48.78%);There were 8(19.51%)patients with Grade 2,13(31.71%)patients with grade 3,and 20(48.78%)patients with grade 4.The amplitude of TES-MEPs decreased by more than 50% in 15 patients(36.59%).The minimum age of patients was 21 years old,the maximum age was 79 years old,and the average age was 50.805 years old.The minimum operation time was 3hours,the maximum was 7 hours,and the average time was 4.951 hours.The minimum and maximum values of intraoperative high frequency monopole subcortical electrical stimulation(HF-SCS)were 2m A,15 m A,and 7.195 m A on average.On the first day after surgery,14(34.2%)of 41 patients showed decreased limb muscle strength compared with those before surgery.The Chi-square test showed that the reduction of TES-MEPs amplitude ≥50% during the operation was the possible influencing factor for the short-term postoperative limb motor function of patients(P < 0.05),while gender,history of hypertension,history of diabetes,tumor location,DTI results and pathological classification were not the possible influencing factors for the short-term postoperative limb motor function of patients(P > 0.05).Quantitative factors were tested first,and it was concluded that the age of patients was in line with normal distribution(P >0.05),while the operation duration and intraoperative HF-SCS stimulation threshold were not in line with normal distribution(P < 0.05).The T-test results of age and the rank sum test results of operation duration suggested that they were not possible factors affecting the short-term postoperative limb motor function of patients(P > 0.05).The rank sum test results of intraoperative HF-SCS stimulation threshold suggested that it was a possible factor affecting the short-term postoperative limb motor function of patients(P < 0.05).The results of binary logistic multivariate regression analysis showed that the amplitude of TES-MEPs decreased by more than 50% during the operation,and the stimulation threshold of HF-SCS during the operation were independent factors affecting the postoperative limb motor function of patients(P < 0.05).Three months after surgery,all 41 patients(100%)showed no decline in limb muscle strength compared with that before surgery,that is,all factors in this study had no effect on the long-term postoperative limb motor function of patients.Conclusion:(1)The reduction of the amplitude of TES-MEPs ≥50% during the operation and the stimulation threshold of HF-SCS can be used to predict the short-term postoperative limb motor function of patients with glioma in motor functional area using HF-SCS technology.(2)Under the premise of protecting patients’ long-term limb motor function,"≥2m A" can be taken as the safe range of HF-SCS stimulation threshold in glioma operation in motor functional area using HF-SCS technology.