唤醒麻醉下直接电刺激语言区定位在切除语言区胶质瘤中的作用

Role of positioning of the language area by direct electrical stimulation in the removal of glioma in the language area under awake anesthesia

目的探讨皮质直接电刺激(DES)在语言区胶质瘤切除术中的应用价值。方法回顾性分析91例大脑语言区胶质瘤病例的临床资料,均在唤醒麻醉下以皮质DES测定脑功能区,并最大程度切除肿瘤。结果直接电刺激结果:88例(125个阳性刺激点)病人出现运动发作(面部或手),91例(112个阳性点)出现语言障碍(包括数数中断、命名错误或不能命名)。肿瘤全切除53例(58.2%),次全切除31例(34.1%),部分切除7例(7.7%)。术后无神经功能障碍42例(46.2%),短暂神经功能障碍并恢复48例(52.7%),出现永久性神经功能障碍1例(1.1%)。结论皮质DES是一种可靠、精确、安全的脑功能区定位方法,可在保留术后语言功能的前提下,最大程度切除语言区胶质瘤。

Objective To explore the applied value of direct electrical stimulation（DES） in surgery for gliomas located in the language area.Methods The clinical data of 91 patients with gliomas in the language area who underwent awake craniotomy with DES for functional mapping of the eloquent areas were analyzed retrospectively.The maximal resection of the tumors and minimal damage to the eloquent area were the goal of the surgery.Results The motor response of the face or hand to DES was detected at 125 cortical sites in 88 patients and language disorder（such as discontinue of counting and error or disability of naming） was found at 112 sites in 91 patients.The total resection were achieved in 53 patients（58.2%）,subtotal in 31（34.1%） and partial in 7（7.7%）. There was no postoperative neurological dysfunction in 42 patients（46.2%）,transitory postoperative neurological dysfunction in 48（52.7%） and permanent neurological deficits in 1（1.1%）.Conclusion Intraoperative DES is a reliable,precise and safe method for functional mapping of the eloquent area.This technique allows us to achieve ＇maximal safe resection＇ in surgery for gliomas in language areas.