功能区胶质瘤的术中直接电刺激判断核心手术技术

Intraoperative electrical stimulation for mapping of eloquent brain areas

目的分析术中直接电刺激判断大脑功能区的手术技术.方法回顾性分析25例大脑半球胶质瘤手术切除技术,及fMRI与DTI在辅助判断肿瘤与功能区的作用.通过术中直接电刺激判断大脑功能区,最大程度切除肿瘤,提高病人术后Karnofsky生活状态(KPS)评分.结果19例术前KPS 80～90分的病人(术前平均85.8分)术后恢复至平均95.3分,6例KPS 40～70分病人术后恢复至平均73.3分;MRI示肿瘤全切23例,肿瘤大部切除2例.结论术中直接电刺激有助于判断大脑功能区位置,从而以最小的损伤,最大程度切除胶质瘤.

Objective To analyze the roles of the intraoperative electrical stimulation in judgment of eloquent brain areas. Methods The resections of gliomas in 25 cases and the roles of functional magnetic resonance imaging and DTI in mapping of gliomas and eloquent brain areas were analyzed retrospectively. The intraoperative electrical stimulation for judgment of eloquent brain areas permitted aggressive resection of gliomas and improved patients' postoperative Karnofsky Performance Status (KPS). Results Score improved from average 85.8 to 95.3 in patients with KPS scores ranged form 80 to 90, and to 73.3 with KPS scores from 40 to 70. Postoperative MRI showed total removal was achieved in 23 cases, and subtotal removal in 2. Conclusion Intraoperative electrical stimulation permits identification of eloquent brain areas and aggressive resection of gliomas with minimal invasiveness to the surrounding brain tissue.