唤醒麻醉联合电刺激技术应用于语言功能区癫痫手术的效果

Efficacy of Wake-up Anesthesia Combined with Electrical Stimulation in Language Area Epilepsy Surgery

目的探讨唤醒麻醉联合电刺激技术应用于语言功能区癫痫手术中的效果。方法选取25例行全身麻醉术的语言功能区癫痫患者,术中予以唤醒并进行皮层电刺激定位语言功能区,根据皮层脑电图定位的致痫灶与语言功能区关系选择相应手术方式,并且在切除致痫灶时作皮层电刺激以保护语言功能区。观察术中情况、手术前后语言功能、病理结果及癫痫控制效果[采用恩格尔癫痫预后分级(Engel)评价]。结果1)术中情况:术中脑膨出2例均经相应处理后恢复正常颅内压,术中电刺激引发癫痫发作4例;2)术后病理结果:胶质增生8例,局灶性皮层发育不良(FCD)7例,海绵状血管瘤4例,星形细胞瘤3例,结节性硬化3例;3)手术前后语言功能:与术前比较,患者术后失语、构音障碍和图片命名功能无明显变化,差异无统计学意义(P>0.05);4)癫痫控制效果:EngelⅠ级17例,EngelⅡ级7例,EngelⅢ级1例。结论全身麻醉术中唤醒电刺激技术可以准确定位语言功能区,提高邻近语言功能区癫痫病例的手术疗效和安全性。

Objective To investigate the efficacy of wake-up anesthesia combined with electrical stimulation in language area epilepsy surgery.Methods Twenty-five patients were given wake-up and electrical stimulation of language area during language area epilepsy surgery under general anesthesia.Surgical procedures were selected according to the relationship between cortical EEG-located epileptogenic foci and language area.Furthermore,cortical electrical stimulation was performed to protect language area during epileptogenic focus excision.Intraoperative conditions,preoperative and postoperative language function,pathological results,and epilepsy control(Engel grades)were observed in all patients.Results(1)Intraoperative conditions:intraoperative encephalocele occurred but intracranial pressure returned to normal after corresponding treatment in 2 cases,and intraoperative electrical stimulation-caused epilepsy occurred in 4 cases.(2)Postoperative pathological results:gliosis was found in 8 cases,focal cortical dysplasia in 7 cases,cavernous hemangioma in 4 cases,astrocytoma in 3 cases,and nodular sclerosis in 3 cases.(3)Language function:no significant changes in aphasia,dysarthria and picture naming were observed after operation(P>0.05).(4)Epilepsy control:Engel gradeⅠwas achieved in 17 cases,Ⅱin 7 cases,andⅢin 1 case.Conclusion Wake-up combined with electrical stimulation during surgery under general anesthesia can accurately locate language function area so as to improve the efficacy and safety of language area epilepsy surgery.