清醒麻醉下切除脑功能区胶质瘤

Resection of glioma in cerebral eloquent areas under awake anesthesia

目的探讨清醒麻醉下切除脑功能区胶质瘤的手术技巧及疗效。方法回顾性分析6例脑功能区胶质瘤病人的临床资料,均在神经阻滞、清醒麻醉下手术,术中神经导航、超声及神经电生理监测定位;切除肿瘤时,维持病人出声连续计数或读图的语言功能监测,或持续按键的运动功能监测。结果术中麻醉满意,肿瘤全切除5例,次全切除1例。术后神经功能障碍均不同程度好转;癫未再发作1例,药物可控制3例。术后出现偏瘫2例,术后无疼痛回忆。结论清醒麻醉下切除脑功能区胶质瘤,结合术中定位明确肿瘤切除范围,及肿瘤与脑功能区的关系,可最大限度地切除脑功能区病变和保护脑功能。

Objective To study the surgical skills and effect for resection of glioma in cerebral eloquent areas under awake anesthesia.Methods Clinical data of 6 patients with gliomas in cerebral eloquent areas were analyzed retrospectively.The patients underwent nerve block and awake anesthesia in the surgical process,and assisted with location by neuro-navigation,ultrasound and neurophysiological monitoring.During the tumor resection,the language function monitoring by continuous counting or picture reading,or the motor function monitoring by keeping pressing the key were performed in the patients.Results All the patients received satisfied anesthesia during the operation.Total tumor resection was achieved in 5 patients and subtotal resection in 1.All the neurological dysfunction was improved to different degrees postoperatively.The epileptic patient had never seizure in 1 case and the other 3 could be controlled of seizure by medication.The hemiplegia occurred in 2 patients postoperatively,and all the patients had no painful memory after the operation.Conclusions Resection of gliomas in cerebral eloquent areas under awake anesthesia,assisted with intraoperative tumor location to define the resection range and the relationship between tumor and cerebral eloquent areas can achieve maximal resection of the lesion and protection of brain function.