中央沟神经电生理定位在中央沟附近胶质瘤切除术的应用价值

The clinical effect of intraoperative electrophysiological localization of eloquent brain areas in resection of glioma near the central sulcus

目的评估中央沟附近胶质瘤切除术中中央沟定位神经电生理技术的临床价值及安全性。方法选择2014年6月至2016年1月62例在新疆医科大学第二附属医院住院接受中央沟附近胶质瘤切除术治疗的患者,依据神经电生理定位技术差异分为:对照组,25例,应用皮质体感诱发电位(Co-SEP)行术中中央沟定位;研究组,37例,应用Co-SEP及皮层直接电刺激术(Co-ST)行术中中央沟定位。两组患者术中均接受全麻术中唤醒治疗。比较两组患者肿瘤切除情况以及术后肢体功能障碍恢复情况的差异。随访2年,比较两组患者生存率及平均生存期的差异,比较两组患者的不良反应发生率的差异。结果与对照组比较,研究组的显微镜下肿瘤全切除率及次全切除率均较高(均P<0.05),术后肢体功能障碍恢复率更优(P<0.05)。两组均无手术死亡病例,唤醒程度无差异(P>0.05)。随访2年,研究组的生存率及平均生存期均高于对照组(均P<0.05)。两组患者的癫痫、脑膨出、寒战及疼痛的不良反应发生率无差异(均P>0.05)。结论应用中央沟附近胶质瘤切除术中通过Co-SEP和Co-ST神经电生理技术联合进行中央沟定位,对术后临床疗效及预后效果更佳且安全性好。

Objective To evaluate the clinical effect and safety of intraoperative electrophysiological localization of eloquent brain areas in resection of glioma near the central sulcus.Methods 62 patients received the resection of glioma near the central sulcus in the second affiliated hospital of Xinjiang medical university were collected from Jun 2014 to Jan 2016.And all patients were divided into two groups based on the method of the electrophysiological localization,which were control group[25 cases,received the cortical somatosensory evoked potential（CoSEP）]and the research group[37 cases,received the methods of Co-SEP and the cortical direct electrical stimulation（Co-ST）].All patients were received the general anesthesia and the intraoperative waken-up.The degrees of the resection of glioma and the recovery of preoperative neurological limb dysfunction were compared between two groups at post-therapy.Follow-up 2 years,the indexes of survival rates and mean survival time were compared between two groups,and the occurrences of adverse reaction were compared between two groups.Results Compared to control group,the total resection rate and subtotal resection rate under the microscope of research group were higher（all P〈0.05）and the recovery rates of preoperative neurological limb dysfunction of research group were also higher（P〈0.05）.There were no operative deaths in two groups and the awake degrees were no different between two group（P〉0.05）.Follow-up 2 years,the indexes of survival rates and mean survival time of research group were higher than of control group（all P〈0.05）.The occurrences of adverse reactions,such as epilepsy,encephalocele,shiver and pain,were no different between two group（all P〉0.05）.Conclusion The intraoperative electrophysiological localization of Co-SEP combined with Co-ST to eloquent brain areas in resection of glioma near the central sulcus is better and the safe.