唤醒麻醉结合皮层电刺激下切除皮层语言区病变21例临床分析

Craniotomy directed by awake anesthesia combined with cortical electrical stimulation in resection of lesions in cortical language areas: a clinical analysis of 21 cases

目的探讨唤醒麻醉结合皮层电刺激开颅手术切除语言功能区病变的价值。方法回顾性分析21例唤醒麻醉结合皮层下电刺激开颅手术术前准备、术中过程、术后康复等临床资料,所有病变均位于或紧邻语言功能区,病人均实施唤醒麻醉,术中先用双极电刺激器确定语言功能区,在确定的语言功能区外1cm,最大范围切除病变。结果病变全切17例(80.95%),次全切4例(19.05%)。术后短期运动性失语1例(4.76%),术中癫痫1例(4.76%),术后颅内血肿1例(4.76%)。远期复发2例,均为胶质瘤次全切除病人(9.52%),余患者恢复良好。结论唤醒开颅结合皮层电刺激手术可最大范围切除语言功能区病变,保护患者言语功能。

Objective To investigate the value of craniotomy directed by awake anesthesia combined with cortical electrical stimulation in the resection of the lesions in cortical language areas. Methods A total of 21 patients whose lesions were located in or near cortical language areas were admitted to our hospital from August 2011 to December 2013. They were given craniotomy directed by awake anesthesia combined with cortical electrical stimulation. All lesions were resected under awake anaesthesia. The cortical language areas were identified by intraoperative cortical electrical stimulation（ bipolar）,and then the lesions were resected as completely as possible.Their clinical data such as preoperative preparation,intraoperative process,postoperative rehabilitation were retrospectively analyzed.Results Total tumor resection was achieved in 17（ 80. 95%） out of 21 patients,and subtotal resection was performed in 4 patients（ 19. 05%）. One case（ 4. 76%） was found to have motor aphasia during the first two weeks of follow-up,epilepsy occurred in one person（ 4. 76%） during the operation,and intracranial hematoma occurred in one patient（ 4. 76%） after the operation. The gliomas of two patients（ 9. 52%） who had used subtotal tumor resection recurred. The other patients had good clinical outcomes.Conclusions The lesions in cortical language areas can be resected by the craniotomy directed by awake craniotomy combined with cortical electrical stimulation to the utmost extent,and the language function can be protected effectively.