语言功能区定位与近语言功能区癫癎灶切除(附11例分析)  

Location of the cortical language area and resection of adjacent epileptogenic zone in refractory epilepsy:analysis of 11 cases

作　　者：遇涛[1] 张国君[1] 于爱红[1] 乔梁[1] 孙伟[2] 倪端宇[1] 蔡立新[1] 李勇杰[1] 

机构地区：[1]首都医科大学宣武医院北京功能神经外科研究所,北京100053 [2]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国微侵袭神经外科杂志》2009年第11期483-486,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金资助项目(编号:30800265)

摘　　要：目的探讨以皮质电刺激为基础的语言功能区皮质的定位方法。方法总结11例癫癎灶邻近语言区病人的治疗经验。将格栅状皮质电极覆盖于脑皮质表面,其中Broca区6例,Wernicke区5例;应用皮质电刺激定位出语言功能区8例,阴性3例;功能磁共振显示语言功能区移位2例。在癫癎灶切除过程中,采用局麻2例,术中拔除喉罩2例,常规气管插管全麻7例;术中注意保留具有语言功能的皮质。结果术后出现一过性语言不流利2例,余9例无明显语言功能障碍。术后随访1年以上,EngelⅠ级8例,Ⅲ级2例,Ⅳ级1例。结论采用埋植式颅内电极进行语言皮质功能绘图方法,可较精确地定位癫癎病人的语言功能区。Objective To explore the technology for cortical language mapping by electrical cortical stimulation. Methods Clinical treatment experiences for 11 patients with epileptogenic zone near the language areas were summarized. Grid-like cortical electrodes were implanted on the surface of the cortices involving Broca area in 6 patients and Wemicke area in 5. The cortical language area was located in 8 patients, and negative in other 3; functional magnetic resonance imaging showed shift of language area in 2 patients. During the resection of epileptogenic focus, local anesthesia was used in 2 patients, general anesthesia with laryngeal mask in 2 and tracheal intubation anesthesia in 7. The functional language cortices should be protected carefully during the surgery. Results Transient speech disfluency was observed in 2 patients and no language dysfunction in 9 patients. Follow-up for a more than one year revealed that Engel class Ⅰ was achieved in 8 patients, III in 2 and 1V in 1. Conclusion Electrical cortical stimulation with intracranial electrodes is useful for accurate mapping of the language area in patients with epilepsy.

关 键 词：脑图 皮质电刺激 语言功能区 癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.1[医药卫生—临床医学]