摘要
目的探讨术中唤醒麻醉技术下脑功能区肿瘤继发癫痫切除术的适应证、技术要点及疗效。方法选择解放军第一五三医院神经外科自2006年6月至2012年6月收治的脑功能区33例胶质瘤及16例脑膜瘤继发癫痫患者，采用MRI进行肿瘤定位，弥散张量纤维束成像（DTT）显示白质纤维束与肿瘤位置关系，功能磁共振成像（fMRll定位运动功能区，在全麻-唤醒-再全麻技术下开颅．实时B超、皮层脑电图fECoG）定位肿瘤及致痫区，显微手术切除肿瘤及处理致痫灶。结果有44例患者顺利经过全麻-唤醒-再全麻的过程，其中28例术中持续保留喉罩；16例语言区肿瘤唤醒后拔除喉罩，语言区定位及功能测试后再置入喉罩全麻。年龄偏大的3例胶质瘤及2例脑膜瘤患者因唤醒时躁动、憋气，脑组织膨出明显，放弃唤醒麻醉。术中神经电生理监测（10M）定位出脑功能区36例，皮层功能定位阴性8例：ECoG监测发现瘤周皮层致痫灶31例。胶质瘤全切22例，次全切8例：脑膜瘤全切13例，次全切1例，术中未出现癫痫发作现象。术后暂时性神经功能障碍加重或新发功能障碍26例，均于1月内恢复；术前原有功能障碍均好转。癫痫发作完全消失31例．发作次数明显减少13例。结论术中全麻唤醒下手术治疗功能区肿瘤继发癫痫疗效好、风险低。术前适应证的选择、术中合适的手术体位的摆放及有效预防癫痫发作是手术成功的重要因素。
Objective To investigate the indication, operative main points of resection of tumor and epileptogenic foci in eloquent cortical area and its curative effect under intra-operative awake anaesthesia. Methods Forty-nine consecutive patients suffering from epilepsy secondary to gliomas （n=33） and meningomas （n=16） in eloquent area, admitted to our hospital from June 2006 to June 2012, were chosen in our study. MRI was employed to detect the location of the tumors; diffusion tensor imaging （DTT） was used to display the location of white matter fiber tracts with the tumor, and functional magnetic resonance imaging （fMRI） was used to detect the motion ftmctional zone; the epileptogenic foci and the anatomical boundary of the minors were localized by electrocorticography （ECoG） monitoring and real-time ultrasound, respectively; microneurosurgery was under asleep-awake-asleep-technique performed to resect the tumors and epileptogenic foci. Results Forty-four patients underwent surgery under asleep-awake-asleep, successfully, including 28 remaining laryngeal mask, 16 pulling out laryngeal mask and again inserting it after language mapping. Five old patients gave up awake-anaesthesia because of restlessness, breath holding and brain tissue being bulged severely. The cerebral functional zones of 36 patients were located by IOM and 8 were without noting eloquent area. Epileptogenic foci werediscovered in 31 patients by ECoG monitoring. Gliomas total resection was achieved in 22, and subtotal resection in 8. Meningoma total resection was achieved in 13 and subtotal resection in 1. No seizures happened during the operations. The temporary or new dysfimetions aggravated in 26 after the operation, but all got recovery in one month. All patients＇ dysfunction got an improvement obviously. Epileptic seizure disappeared completely in 31 patients and decreased obviously in 13 patients. Conclusion Surgery of tumors and epileptogenic foci in eloquent cortical area under awake-anaesthesia can maximally remove the tumors safely, protect cerebral function maximally and treat secondary epileptogenic foci safely; selection of preoperative indications, intra-operative proper operative position and effective prevention of epileptic seizure are the keys of success surgery.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2013年第7期675-679,共5页
Chinese Journal of Neuromedicine
关键词
脑功能区
脑肿瘤
继发性癫痫
唤醒麻醉
术中神经电生理监测
皮层
脑电图
Cerebral functional area
Tumor
Secondary epilepsy
Awake anaesthesia
Intra-operative neurophysiologic monitoring
Electrocorticography
