Potencial evocado auditivo na monitorização de 15 microlaser cirurgias do tronco cerebral

Pimenta, Luiz Henrique Mattos; Luccas, Francisco J. Carchedi; Souza, Heider Lopes; Medugno, Eduardo

doi:10.1590/S0004-282X1989000400009

Resumos

Baseados na experiência de 15 casos, os autores salientam a importância do uso sistemático do potencial evocado auditivo do tronco cerebral na monitorização peroperatória do tronco cerebral, área das mais delicadas do cérebro, evitando que o cirurgião seja advertido pelo anestesista de que seu paciente está apresentando bradicardia ou arritmia. Apenas a cirurgia com Laser (acoplado a microscópio) permite monitorização contínua, sem interferência de aparelhagem elétrica. Além disso, nos casos relatados, foi verificada a existência de alterações da fisiologia do tronco cerebral quando usados o bipolar ou micro-dissectores, o que não ocorre com o Laser a. CO2.

Based upon the results observed in 15 patients submitted to tumor ressection by the CO2 microlaser technique and submitted to brain stem auditive evoked potential (BAEP) intraoperative determination, the authors emphazise the importance of the technique. BAEP during the intraoperative period and the ultrasonic control of removal of tumors proved useful in the 15 cases of brain stem tumors or tumor adherent to it. Morbidity and mortality are described, and the important changes in BAEP that precede bradicardia are detailed. The importance of advances obtained through BAEP in peroperative control in such surgeries is stressed.

Potencial evocado auditivo na monitorização de 15 microlaser cirurgias do tronco cerebral

Auditive evoked potential in the monitorization of 15 microlaser surgeries of the brain stem

Luiz Henrique Mattos Pimenta^I; Francisco J. Carchedi Luccas^II; Heider Lopes Souza^III; Eduardo Medugno^IV

^IProfessor Adjunto do Departamento de Neurocicurgia da Faculdade de Medicina de Jundiaí, Presidente da Associação Brasileira de Laser

^IIChefe do Departamento de Neurofisiologia, HAE

^IIIResidente de Neurocirurgia, Escola Paulista de Medicina

^IVAssistente de Neurocirurgia, HAE

RESUMO

Baseados na experiência de 15 casos, os autores salientam a importância do uso sistemático do potencial evocado auditivo do tronco cerebral na monitorização peroperatória do tronco cerebral, área das mais delicadas do cérebro, evitando que o cirurgião seja advertido pelo anestesista de que seu paciente está apresentando bradicardia ou arritmia. Apenas a cirurgia com Laser (acoplado a microscópio) permite monitorização contínua, sem interferência de aparelhagem elétrica. Além disso, nos casos relatados, foi verificada a existência de alterações da fisiologia do tronco cerebral quando usados o bipolar ou micro-dissectores, o que não ocorre com o Laser a. CO₂.

SUMMARY

Based upon the results observed in 15 patients submitted to tumor ressection by the CO₂ microlaser technique and submitted to brain stem auditive evoked potential (BAEP) intraoperative determination, the authors emphazise the importance of the technique. BAEP during the intraoperative period and the ultrasonic control of removal of tumors proved useful in the 15 cases of brain stem tumors or tumor adherent to it. Morbidity and mortality are described, and the important changes in BAEP that precede bradicardia are detailed. The importance of advances obtained through BAEP in peroperative control in such surgeries is stressed.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Hospital Albert Einstein (HAE), São Paulo.

Dr. L. H. Mattos Pimenta - Rua José Maria Lisboa 356 apto 33 - 01423 São Paulo SP - Brasil.

¹
Ascher PW - Absolute indications for laser use in neurosurgery. In Proceeding's Panamerican Congress of Neuro Laser, Sept. 22-26, Rio de Janeiro, 1986, pg 36.
²
Hardy RW Jr, Kinney SE, Lueders H - Preservation of cochlear nerve function with the aid of brainstem auditory evoked potentials. Neurosurgery 11: 16, 1982.
³
Hashimoto I, Ishiyama Y, Otsuka G, Mizutani H - Monitoring brainstem function during posterior fossa surgery with brainstem auditory evoked potentials. In Barber C (ed): Evoked Potentials. MTP Press, Lancaster, 1980, pg 377.
⁴
Hashimoto I, Ishiyama Y, Otsuka G, Mizutani H - Bilateral recorded brainstem auditory evoked responses: their asymmetrical abnormalities and lesion of the brainstem. Arch Neurol 36: 161, 1979.
⁵
Hausler R, Levine RA - Brainstem auditory evoked potentials are related to interaural time discrimination in patients with multiple sclerosis. Brain Res 191:589, 1980.
⁶
Kohlt A, Slodan TB - The use of evoked potentials and cortical mapping during laser neurosurgery. In Proceedings of the First Congress of LANSI. Salzburg, 1984, pg 11.
⁷
Ojemann RG, Levine RA, Montgomery WM, McGaffigan P - Use of intraoperative auditory evoked potentials to preserve hearing in unilateral acoustic neuroma removal. J Neurosurg 61: 938, 1984.
⁸
Pimenta LHMP - CO₂ Laser first experiences in neurosurgery. Seara Med Neurocir 4: 377, 1978.
⁹
Raudenz PA - Intraoperative monitoring of evoked potentials. Ann NY Acad Sci 388: 308, 1982.
¹⁰
Starr A - Clinical relevance of brainstem auditory evoked potentials in man: psyho-pharmacology correlates of EPs. Progress in Clinical Neurophysiology, Vol 2. Karger, Basel, 1977, pg 45.
¹¹
Stellar S - Laser in surgery. In Wolbarsht ML (ed): Laser Aplications in Medicine and Biology, Vol 2, 1969, pg 241.
¹²
Takizawa T - Laser surgery of brain tumors. No Shenkei geka 9, 743, 1987.
¹³
Urcioli R - Laser use in neurosurgery and anaesthetic considerations. In Proceedings of American Congress of Soc Neurosurgical Anesthesia and Neurologic Supportive Care, Las Vegas, 1982, pg 33.
¹⁴
Urcioli R - Anesthesiological techniques in laser neurosurgery. In Fason (ed): Advanced Intraoperative Technologies in Neurosurgery. Springer, Wien, 1986, pg 228.

Datas de Publicação

Publicação nesta coleção
01 Jun 2011
Data do Fascículo
Dez 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] ¹
Ascher PW - Absolute indications for laser use in neurosurgery. In Proceeding's Panamerican Congress of Neuro Laser, Sept. 22-26, Rio de Janeiro, 1986, pg 36.

[2] ²
Hardy RW Jr, Kinney SE, Lueders H - Preservation of cochlear nerve function with the aid of brainstem auditory evoked potentials. Neurosurgery 11: 16, 1982.

[3] ³
Hashimoto I, Ishiyama Y, Otsuka G, Mizutani H - Monitoring brainstem function during posterior fossa surgery with brainstem auditory evoked potentials. In Barber C (ed): Evoked Potentials. MTP Press, Lancaster, 1980, pg 377.

[4] ⁴
Hashimoto I, Ishiyama Y, Otsuka G, Mizutani H - Bilateral recorded brainstem auditory evoked responses: their asymmetrical abnormalities and lesion of the brainstem. Arch Neurol 36: 161, 1979.

[5] ⁵
Hausler R, Levine RA - Brainstem auditory evoked potentials are related to interaural time discrimination in patients with multiple sclerosis. Brain Res 191:589, 1980.

[6] ⁶
Kohlt A, Slodan TB - The use of evoked potentials and cortical mapping during laser neurosurgery. In Proceedings of the First Congress of LANSI. Salzburg, 1984, pg 11.

[7] ⁷
Ojemann RG, Levine RA, Montgomery WM, McGaffigan P - Use of intraoperative auditory evoked potentials to preserve hearing in unilateral acoustic neuroma removal. J Neurosurg 61: 938, 1984.

[8] ⁸
Pimenta LHMP - CO₂ Laser first experiences in neurosurgery. Seara Med Neurocir 4: 377, 1978.

[9] ⁹
Raudenz PA - Intraoperative monitoring of evoked potentials. Ann NY Acad Sci 388: 308, 1982.

[10] ¹⁰
Starr A - Clinical relevance of brainstem auditory evoked potentials in man: psyho-pharmacology correlates of EPs. Progress in Clinical Neurophysiology, Vol 2. Karger, Basel, 1977, pg 45.

[11] ¹¹
Stellar S - Laser in surgery. In Wolbarsht ML (ed): Laser Aplications in Medicine and Biology, Vol 2, 1969, pg 241.

[12] ¹²
Takizawa T - Laser surgery of brain tumors. No Shenkei geka 9, 743, 1987.

[13] ¹³
Urcioli R - Laser use in neurosurgery and anaesthetic considerations. In Proceedings of American Congress of Soc Neurosurgical Anesthesia and Neurologic Supportive Care, Las Vegas, 1982, pg 33.

[14] ¹⁴
Urcioli R - Anesthesiological techniques in laser neurosurgery. In Fason (ed): Advanced Intraoperative Technologies in Neurosurgery. Springer, Wien, 1986, pg 228.