小儿难治性癫■病灶唤醒手术切除的麻醉管理

Anesthesia management of awake craniotomy for the resection of refractory seizure foci in children

目的总结小儿难治性癫[疒间]唤醒开颅手术的麻醉管理。方法回顾性分析23例额颞叶难治性癫[疒间]病儿的临床资料,均采用唤醒开颅手术切除致[疒间]灶。结果22例均顺利完成唤醒下病灶切除,其中采用入睡-清醒-再入睡模式进行麻醉14例,入睡-清醒模式8例;余1例病儿在唤醒后无法配合,后在全麻下完成手术。术后并发症:术中疼痛9例,恶心4例,癫[疒间]发作8例,寒战4例,对症处理后好转。随访23例,时间2~5年,无一例发生重要神经功能损伤,Engel分级:Ⅰ级12例,Ⅱ级8例,Ⅲ级3例。结论唤醒麻醉可以安全地用于小儿癫[疒间]功能区病灶切除手术,小儿的年龄和认知程度对唤醒麻醉的成功实施有较大影响。

Objective To summarize the management of anesthesia for awake craniotomy in children with refractory epilepsy.Methods Clinical data of 23 patients with refractory epilepsy in frontal and temporal lobes were analyzed retrospectively,who underwent awake craniotomy to resect the seizure focus.Results The seizure focus was resected successfully in 22 patients by awake craniotomy,including anesthesia model of asleep-awake-asleep in 14 patients and asleep-awake in 8.One patient who could not cooperate with the surgeon after being awakened received surgery under general anesthesia.The postoperative complications were as follows:ache during surgery in 9 patients,nausea in 4,seizure in 8 and rigor in 4.All the patients recovered after symptomatic treatment.All the patients were followed up for 2 to 5 years,no important neurofunction impairment occurred.Engel gradeⅠwas observed in 12 patients,gradeⅡin 8 and gradeⅢin 3.Conclusions Awake anesthesia can be used safely in epilepsy surgery for resection of the focus in the functional area in children.The age and cognition of the children have a great influence on awake anesthesia.