唤醒麻醉和术中功能定位切除语言区胶质瘤  

Awake craniotomy and intraoperative functional mapping for surgery of gliomas located in language areas

作　　者：张忠[1] 江涛[1] 谢坚[1] 刘福生[1] 韩如泉[2] 陈新忠[2] 乔慧[1] 李子孝[3] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100050 [2]首都医科大学附属北京天坛医院麻醉科,北京100050 [3]首都医科大学附属北京天坛医院神经内科,北京100050

出　　处：《中华神经外科杂志》2007年第9期643-645,共3页Chinese Journal of Neurosurgery

基　　金：十一五国家科技支撑计划;首都医学发展科研基金(2007BA105808)

摘　　要：目的探讨语言功能区胶质瘤的手术策略。方法回顾性分析手术治疗30例语言功能区胶质瘤。在唤醒麻醉下应用术中直接皮质电刺激确定语言区,根据功能边界切除肿瘤。评价患者的功能结果及切除程度。结果术中语言功能区监测成功20例;未监测到4例;因麻醉或术中高颅压不能进行监测6例。随访3个月,3例患者存在中度语言功能障碍。全切14例,近全切12例,大部切除4例。结论术中皮质电刺激确定语言功能区准确、安全、可靠。唤醒麻醉下进行术中皮质电刺激结合术前神经功能影像技术,确定切除肿瘤的功能边界,能够最大程度切除肿瘤,同时保护正常的语言功能,使术后语言障碍的风险降到最低。Objective To investigate surgical strategies for the resection of gliomas involved language areas. Methods Retrospectively analyzed 30 left-hemisphere dominant patients who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery. All patients had tumors in or next to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with language functional areas preservation. Preoperative and postoperative functional results were evaluated. Results Intraoperative language areas was detected in 20 cases; was undetected in 4 cases; brain mapping was failure for the anaesthesia reasons or intraoperative increase of intracranial pressure in 6 cases. Three patients presented moderate language deficits after 3 months of follow-up. Total resection was achieved in 14 cases, near total resection in 12 cases and subtotal resection in 4 cases. Conclusion Intraoperative cortical electrical stimulation can verify the language cortex accurately and was safe with high reliability. Under awake craniotomy intraoperative cortical electrical stimulation in combination with pre-surgical neurological functional imaging technique to decide the tumor resection border can excise the tumor as much as possible with the preservation of normal language function and minimize the risk of postoperative language deficits.

关 键 词：皮质电刺激 唤醒麻醉 语言定位 胶质瘤 手术 

分 类 号：R614[医药卫生—麻醉学] R739.4[医药卫生—外科学]