术中唤醒直接电刺激技术在功能区较低级别弥漫性胶质瘤切除中的应用价值

The role of direct electrical stimulation under awake craniotomy in resection of diffuse lower-grade glioma in the eloquent brain areas

目的探讨全身麻醉术中唤醒直接电刺激技术在小脑幕上功能区较低级别弥漫性胶质瘤切除中的应用价值.方法回顾性分析2017年2月至2020年7月南部战区总医院神经外科收治的38例小脑幕上功能区较低级别弥漫性胶质瘤患者的临床资料,其中9例为复发肿瘤.患者均采用全身麻醉术中唤醒技术,采用直接电刺激技术定位皮质和皮质下重要功能区.观察患者的肿瘤切除程度及术后神经功能障碍的发生情况.结果术中直接皮质电刺激后,31例(81.6%)患者出现阳性反应,7例(18.4%)为阴性反应.皮质下电刺激后,25例(65.8%)患者出现阳性反应,13例(34.2%)为阴性反应.5例(13.2%)患者皮质及皮质下电刺激均为阴性.肿瘤全切除21例(55.3%),其中超大切除5例;次全切除13例(34.2%);部分切除4例(10.5%).术后3个月内,26例(68.4%)有新发神经功能障碍或原有神经功能障碍加重;术后3个月,4例(10.5%)有轻度或中度的神经功能障碍.9例复发患者中,8例切除至功能区边界,术后3个月,2例有新发轻度神经功能障碍.结论在功能区较低级别弥漫性胶质瘤切除术中应用术中唤醒直接电刺激技术定位脑功能区,有助于在最大安全范围内切除肿瘤,减少手术相关并发症.

Objective To investigate the role of direct electrical stimulation under awake craniotomy in resection of diffuse lower-grade glioma in the eloquent brain areas.Methods A retrospective study was performed on the clinical data of 38 patients with diffuse lower-grade glioma located in supratentorial eloquent areas who were admitted to the Department of Neurosurgery of General Hospital of Southern Theater Command from February 2017 to July 2020.Among the patients,9 had recurrent gliomas.All patients underwent awake craniotomy and direct electrical stimulation was performed to locate the cortical/subcortical important functional areas.The extent of excision and postoperative neurological dysfunction were documented.Results After intraoperative direct electrical cortical stimulation,31 cases(81.6%)showed positive response and 7(18.4%)showed negative response.During subcortical stimulation,25 cases(65.8%)showed positive response and 13 cases(34.2%)showed negative response.Both cortical and subcortical electrical stimulations induced negative response in 5 cases(13.2%).Total resection was achieved in 21 cases(55.3%),including 5 cases with supratotal resection.Subtotal resection was performed in 13 cases(34.2%)and partial resection in4 cases(10.5%).A total of 26 cases(68.4%)had new or aggravated neurological dysfunction within 3 months after surgery and 4 cases(10.5%)had irreversible mild-moderate neurological dysfunction after 3 months.Of the 9 recurrent patients,8 cases underwent resection reaching the boundary of eloquent areas.There were 2 cases who developed mild newly-onset neurological dysfunction at 3 months post operation.Conclusion Brain functional mapping using direct cortical electrical stimulation in awake craniotomy can maximize the extent of safe resection of diffuse lower-grade glioma in the eloquent brain areas and help reduce the incidence of postoperative neurological dysfunction.