直接皮质电刺激在脑功能区手术中对脑功能的保护作用

Protective effect of direct cortical electrical stimulation on brain function during the operation on eloquent areas of brain

目的:探讨脑重要功能区手术中应用直接皮质电刺激联合皮质体感诱发电位定位脑功能区的方法及意义。方法:16例脑重要功能区病变的患者在唤醒麻醉下进行显微外科手术,利用皮质诱发电位及皮质直接电刺激定位感觉区、运动区及语言区,在保护脑功能区功能不受损的前提下,最大限度的手术切除病变。结果:12例位于运动感觉区的患者利用体感诱发电位及皮质电刺激确定出运动感觉区,其中6例利用体感诱发电位总位相倒置确定出中央沟,记录到明显的P20-N25倒置波形,波幅最大及波形分化最佳,经直接皮质电刺激确认为运动区。4例病变位于左侧额颞叶的患者通过皮质直接电刺激确定出语言区。术后无一例出现长期的功能障碍加重,并且术后功能均较术前明显好转。皮质电刺激未出现特殊并发症。结论:术中体感诱发电位及直接皮质电刺激可准确实时确定脑功能区,可最大限度的保护患者功能,最大限度的切除病变。

AIM:To study the methods and significance of cortical mapping by direct cortical electrical stimulation and somatosensory evoked potential(SEP) during the operation on the lesions localized in eloquent areas of brain. METHODS:A total of 16 patients with brain lesions in the eloquent areas received microsurgery under anaesthesia retaining consciousness.SEP and direct cortical electrical stimulation were performed to localize the motor, sensory and speech areas before the lesions removal.The brain lesions were removed as far as possible in the case of eloquent areas preservation. RESULTS:The motor sensory cortex was confirmed by SEP and direct cortical electrical stimulation in 12 patients with lesions in the motor sensory areas.Among them, central sulcus was located in 6 patients by the phase reversal of SEP,showing apparent reversal waveform of P20-N25 with maximum amplitude,and optimal waveform differentiation and the motor area was confirmed by direct cortical electrical stimulation;the speech cortex was ensured by direct cortical electrical stimulation in the 4 patients with frontal temporal lesions.None of the 12 patients had long term dysfunction aggravated,and everyone had an improvement in dysfunction postoperatively. There was no permanent deterioration of functional dysfunction after operation,and the preoperative dysfunction was improved in all patients.There were no notable complications during and after the direct cortical electrical stimulation. CONCLUSION:Intra operative SEP and direct cortical electrical stimulation are reliable, precise and safe to localize eloquent areas of brain,which allows a maximum resection of lesions and protection of the normal function.