术中直接皮层电刺激判断大脑功能区在胶质瘤切除术中的应用

Effect of direct cortical electrical stimulation to brain function area during gliomas resection

目的:试用术中直接电刺激判断大脑功能区的位置和范围的方法,以求术中最大程度切除肿瘤,减少神经系统损伤。方法:对唤醒麻醉下手术切除优势半球语言区胶质瘤患者26例以及邻近或累及脑运动功能区胶质瘤患者26例,在术中直接行皮层刺激,判断功能区的位置和肿瘤的关系。结果:患者在唤醒麻醉下,利用直接皮质电刺激可以准确定位初级运动皮质区和语言功能区,术后患者Karnofsky生活状态(KPS)评分结果较术前提高。结论:在唤醒麻醉下,可检测到患者的运动和语言的脑功能区,并可判断与肿瘤位置的关系。术中采用直接皮质电刺激可定位脑重要功能区,能最大限度地切除病变,最大限度地保护脑功能区。

Objective：Application of direct cortical electrical stimulation during operation of gliomas for inducing neurological sequelae , when the tumor is located whthin eloquent brain areas . Methods： To resect gliomas in 26 patients involving language functional area and 26 patients involving motor function area , the intraoperative electrical stimulations were performed for judgment of eloquent brain area. Resuits： The motorcortex area and language area were comfirmed by direct cortical electrical stimulation under the awake anesthesia . Compared with the patients preoperative evaluation , the postoperative neurological examination and KPS scores were obviously improved . Conclusion： Intraoperative direct cortical electrical stimulation under awake anesthesia is reliable to preciselty localize brain eloquent area ,which allows a maximum resection of the gliomas and protection of the normal function .