| Objective:To evaluate the prognosis of surgical treatment for motor function area tumors using total intravenous anesthesia assisted by intraoperative high-frequency direct cortical stimulation(DCS)and direct subcortical electrical stimulation(DsCS)versus traditional transcranial electrical motor evoked potentials(Tce MEPs)monitoring and provide a clinical reference.Methods:This study retrospectively analyzed the patients with brain tumors in the functional area of the motor area who were treated in the Department of Neurology,the First Bethune Hospital of Jilin University,from October 2020 to December 2022.Patients who underwent high-frequency monopolar direct cortical stimulation and subcortical stimulation during the operation were grouped as TceMEPs+DsCS,while those monitored by transcranial electrical motor evoked potentials(Tce MEPs)were grouped as TceMEPs.The relevant data of the patients were collected,including the preoperative and postoperative status of the patient’s Clinical manifestations,preoperative and postoperative muscle strength,imaging data,etc.,and the patients were followed up to collect relevant data.We utilized SPSS 26.0 software for processing and statistical analysis to investigate and compare the degree of tumor resection and postoperative nerve function injury.KPS score between patients who received high-frequency monopolar stimulator combined with direct cortical stimulation and subcortical stimulation during surgery and those who only had transcranial electrical motor evoked potentials(Tce MEPs)monitoring,Reselts:This study included 60 patients who met the criteria,including 26 in the TceMEPs+DsCS group and 34 in the TceMEPs group,including 33 male patients(55.0%)and 27 female patients(45.0%),with an average age of 50.6 years(19-74),Relevant data of all patients were complete and operated on in our hospital.The general data of the two groups(gender,age,preoperative muscle strength,tumor coverage,tumor volume,preoperative KPS score,and postoperative pathological type)were compared;the results were not statistically significant(P>0.05).The total tumor resection rate in the TceMEPs+DsCS group was 69.2%(18/26),higher than that in the TceMEPs group at 50.0%(17/34).However,there was no significant difference in the degree of tumor resection between the two groups(P>0.05).There was no significant difference in muscle strength between the two groups one week after the operation(P>0.05).After three months of the operation,a significant difference in muscle strength was observed between the two groups(P<0.05).Furthermore,at one week and three months after the operation,the muscle strength of the TceMEPsDDsCS group was statistically significant(P<0.05).Additionally,the KPS score of both groups was significantly different three months after the procedure(P<0.05).Conclusion:Compared to the traditional passive monitoring of Tce MEPs,the intraoperative resection of tumors in the motor area assisted by high-frequency monopolar DCS and DsCS showed an advantage in identifying the motor cortex or pyramidal tract in the resection zone.Specifically,the characteristics of the monopole stimulator’s concentric circle radiation and the corresponding relationship between the stimulation intensity and the distance from the conduction tract of 1 mm≈1 mA resulted in the more precise assessment of the distance between the tumor cutting edge and the pyramidal tract during the operation.It can significantly reduce the risk of various irreversible neurological deficits after surgery,improve the quality of life and life cycle of patients after surgery,and thus provide additional accuracy and safety for neurosurgeons when removing tumors in the motor area. |
