脑功能区胶质瘤的手术策略

The strategies of glioma surgery in cerebral eloquent areas

目的探讨唤醒麻醉状态下切除脑功能区胶质瘤的手术方法及意义。方法13例脑功能区胶质瘤经神经导航病灶定位术中唤醒麻醉,皮层诱发电位及皮层电刺激定位脑功能区,在清醒状态下切除脑功能区病变。结果全部病例均在术中获得安全可靠的麻醉唤醒,清醒状态下脑功能区的定位和最大限度地肿瘤切除,其中6例获得皮层体感诱发电位检测确定中央沟;9例经皮质刺激术明确运动区;4例通过皮质刺激术基本确定语言运动中枢。肿瘤全切11例,次全切除2例。术后出现暂时性神经功能障碍或功能障碍加重有11例,神经功能完全恢复正常10例。1例术中出现癫痫发作,1例在唤醒过程中出现一过性脑肿胀;全部患者术后无痛苦回忆。结论对脑功能区胶质瘤运用唤醒麻醉,神经导航病灶定位,皮层电刺激和皮层诱发电位定位脑功能区技术能较为可靠地明确脑功能区与肿瘤切除范围的关系,在清醒状态下切除肿瘤实时监测脑功能状态,能够最大限度地切除脑功能区病变和最大程度地保护脑功能。

Objective To study the surgical skills of awake surgery of gliomas harboring in eloquent areas. Methods 13 cases of gliomas in eloquent areas were underwent awake surgery procedures assisted with neuro-navigation and brain functional mapping by soma- tosensory evoked potential(SEP) and cortical electrical stimulation. Results All cases received safety awake surgery for accurate location of both lesions and eloquent areas and maximal resection of tumors. The central sulci were located by SEP in 6 cases. 9 cases of motor cortices and 4 cases of motor speech centers were confirmed by direct cortical stimulation. The lesions were totally removed in 11 patients, and subtotal removed in the other 2 patients. There is no deterioration of neurological functional after operation. The preoperative neurological deficits were improved in all patients, and completely disappeared in 10 patients. Only one patient who suffered frequently seizure got an epileptic attack during the awaking period in the operation. And another patient was suffered from brain swelling during the awaking procedure. There were no other complications during or after the operations. All patients had no painful experience due to operations. Conclusions It is a reliable, precise and safe method that intraoperative mapping of eloquent areas by somatosensory evoked potential and cortical electrical stimulation under awaking anaesthesia, which allow a maximum resection of gliomas and protection of brain function.