Интраоперационный нейрофизиологический мониторинг при хирургической коррекции нейромышечного сколиоза: клинико-методологические аспекты и алгоритмы интерпретации (нарративный обзор)

Цель исследования. Обобщить и критически оценить данные об интраоперационном нейрофизиологическом мониторинге при хирургической коррекции нейромышечного сколиоза с акцентом на модальности мониторинга, причинах тревог и алгоритме действий.

Материал и методы. Работа выполнена как практико-ориентированный нарративный обзор с аналитическим обобщением опубликованных данных без проведения формального метаанализа; уровень доказательности – V. Поиск источников проводили в PubMed/Medline, Scopus, Web of Science Core Collection и РИНЦ за период с 01.01.2005 по 22.09.2025 г. с дополнительным ручным поиском.

Результаты. Ключевые модальности – транскраниальные моторные и соматосенсорные вызванные потенциалы, дополненные спонтанной и триггерной электромиографией для контроля корешковых событий и оценки положения транспедикулярных винтов; при низкой мониторируемости возможны эпидуральные ответы (включая D-wave) как резервная тактика. Изменения сигналов при нейромышечном сколиозе обусловлены тремя группами факторов: перфузионно-физиологическими, механическими (маневры коррекции) и анестезиолого-техническими. Обобщен поэтапный алгоритм реакции на тревогу: исключение технических причин, оптимизация перфузии и анестезии, оценка связи с этапом коррекции и решение о модификации маневра.

Заключение. Мультимодальный интраоперационный нейрофизиологический мониторинг повышает безопасность коррекции нейромышечного сколиоза, однако критерии тревоги и тактика должны индивидуализироваться с учетом нозологии, исходного дефицита и этапа коррекции.

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