全麻术中唤醒状态下定位切除额叶功能区致痫灶(附8例报告)

Resection of epileptogenlc zone in eloquent areas by functional mapping under awaking anaesthesia: clinical report of eight cases

目的:初步探讨全麻唤醒状态下精确定位切除额叶功能区致痫灶的方法。为外伤性迟发性癫痫的微侵袭外科手术提供经验。方法:对8例明确由额叶功能区病灶引起的外伤性迟发性癫痫病人进行气管(或喉罩)插管、全麻下神经导航解剖定位开颅,术中麻醉唤醒,在清醒状态下,通过皮质脑电图及皮质电刺激等方法进行额叶运动区和(或)语言区定位,在保护脑功能区的前提下切除致病灶,然后在全麻下关颅。结果:8例病人均顺利经过气管(或喉罩)插管下全麻一术中唤窿一再全麻手术过程,唤醒后额叶功能区均采用神经电生理技术得到精确定位,额叶致痫灶得到最大程度切除,无明显的术后神经功能障碍发生,外伤性癫痫得以治愈或显著改善。无手术并发症,病人术后无痛苦回忆。结论:全麻唤醒状态下进行皮质脑电图及皮质电刺激定位额叶功能区手术有助于安全准确地切除致痫灶,提高外伤性迟发性癫痫病人术后生活质量。

Objective： To study the method of functional mapping for eloquent areas under awaking anaesthesia for resection of the epileptogenic zone in cerebral eloquent areas. Method： Eight cases of epilepsy patients with lesions in the eloquent areas were undergone awaking surgery assisted with neuron- navigation system and functional mapping under awaking anaesthesia. Results; All patients were successfully underwent craniotomy under anaesthesia with endotrachesl intubation or larynx mask and intravenous propofol, the identify of the functional areas and surgical resection of epileptogenic zone under awaking, and close the crenium under re- anaesthesia during the operation. The epfleptogenie zone in eloquent areas of frontal lobe was resected utmostly under cortex EEG end direct electrical stimulation. There were no deterioration of neurofunction after operation. The epilepsy was improved in all patients, end totally disappeared in 6 patients. All patients have no painful experience in the operations. Conclusion： Functional mapping for eloquent areas by cortex EEG and direct electrical stimulation under awaking anaesthesia is a reliable, precise end safe method, which allows a maximum resection ofthe epfleptogenic zone end protection ofthe normal fonetion.