Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Principles of Intraoperative Neurophysiological Monitoring with Insertion and Removal of Electrodes

수술 중 신경계감시검사에서 검사에 따른 전극의 삽입 및 제거방법

  • Lim, Sung Hyuk (Department of Neurology, Institute of Neuroscience Center, Samsung Medical Center) ;
  • Park, Soon Bu (Physiologic Diagnostic Laboratory, Seoul National University Bundang Hospital) ;
  • Moon, Dae Young (Department of Neurosurgery, Ajou University Hospital) ;
  • Kim, Jong Sik (Department of Neurology, Asan Medical Center) ;
  • Choi, Young Doo (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Park, Sang Ku (Department of Neurology, Institute of Neuroscience Center, Samsung Medical Center)
  • 임성혁 (삼성서울병원 뇌신경센터 신경과) ;
  • 박순부 (분당서울대학교병원 특수검사부) ;
  • 문대영 (아주대학교병원 신경외과) ;
  • 김종식 (아산병원 신경과) ;
  • 최영두 (서울대학교병원 신경외과) ;
  • 박상구 (삼성서울병원 뇌신경센터 신경과)
  • Received : 2019.09.03
  • Accepted : 2019.10.08
  • Published : 2019.12.31
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Abstract

Intraoperative neurophysiological monitoring (INM) examination identifies the damage caused to the nervous system during surgery. This method is applied in various surgeries to validate the procedure being performed, and proceed with confidence. The assessment is conducted in an operating room, using subdermal needle electrodes to optimize the examination. There are no textbooks or guides for the correct stimuli and recording areas for the surgical laboratory test. This article provides a detailed description of the correct stimuli and recording parts in motor evoked potential (MEP), somatosensory evoked potential (SSEP), brainstem auditory evoked potentials (BAEP) and visual evoked potentials (VEP). Free-running Electromyography (EMG) is an observation of the EMG that occurs in the muscle, wherein the functional state of most cranial nerves and spinal nerve roots is determined. In order to help understand the test, an image depicting the inserting subdermal needle electrodes into each of the muscles, is attached. Furthermore, considering both the patient and the examiner, a safe method is suggested for removal of electrodes after conclusion of the test.

수술 중 발생하는 신경계 손상 여부를 감별하는 검사인 수술 중 신경계 모니터링(intraoperative neurophysiological monitoring, INM) 검사는 다양한 수술에서 안정적으로 수술이 잘 진행되고 있음을 확신하며 수술을 진행할 수 있도록 도움을 주는 매우 중요한 검사다. 수술실이라는 특수한 환경에서 검사의 최적화를 위하여 침 전극을 사용하여 검사를 진행하며, 수술실검사에 대하여 정확한 자극부위와 측정부위에 대한 교재나 안내책자가 없는 것이 실정이다. 그래서 이번 논문에서 운동유발전위검사, 체성감각유발전위검사, 청각유발전위검사, 시각유발전위검사에서 올바른 자극부위와 측정부위에 대하여 자세하게 설명을 하였다. 그리고 자유진행 및 유발근전도검사(free-running and triggered EMG)는 근육에서 발생하는 근전도의 관찰로 대부분의 뇌신경(cranial nerve)과 척수신경근(spinal nerve root)의 기능상태 파악을 한다. 검사의 이해를 돕기 위해 각각의 해당 근육에 전극을 삽입하는 사진을 첨부하였고, 척수신경근에 따른 해당근육도 표로 제시하였다. 검사 후 전극제거를 할 때에도 환자와 검사자 모두 안전한 방법을 제시하여 보다 완벽한 검사가 되었으면 한다.

Keywords

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