脑功能区胶质瘤的现代手术策略  

Modern surgical strategy for gliomas in eloquent areas

作　　者：白红民[1] 王伟民[1] 梁树杰[2] 李天栋[1] 杨帅[1] 王丽敏[1] 何洹[3] 施冲[3] 王莎莎[4] 

机构地区：[1]广州军区广州总医院神经外科,510010 [2]广州军区政治部东山干休所 [3]广州军区广州总医院麻醉科,510010 [4]广州军区广州总医院超声影像科,510010

出　　处：《临床神经外科杂志》2011年第5期245-248,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨切除脑功能区胶质瘤手术新技术与方法。方法 112例胶质瘤患者在术中全麻唤醒状态下,通过术中B超或神经导航定位病灶,直接电刺激定位脑功能区结构,并在清醒状态下切除病变。术后随访时间3～84个月。结果 107例唤醒良好,术中有99例定位出运动区,61例定位出语言相关的功能区皮质,18例定位出感觉区。病变全切66例,次全切除34例,部分切除12例。术后短暂性一侧肢体活动障碍37例,短暂的语言障碍26例,手术相关的永久性神经功能障碍3例,无手术死亡,全部患者术后无痛苦回忆。结论全麻术中唤醒技术、术中直接电刺激和术中脑超声技术是切除功能区胶质瘤的三项主要技术;综合使用这些技术能够在术中明确脑功能区与肿瘤的关系,做到最大限度地切除脑功能区病变和保护脑功能。Objective To study the new techniques and methods during surgery oI brain gliomas located in supratentorial eloquent areas. Methods 112 patients with supratentorial gliomas were operated under awake anesthesia with ultrasonography for locating the tumor and intra-operative direct electrical stimulation （DES） for functional mapping of the eloquent areas. The maximal resection of tumors and minimal damage of the eloquent areas were the surgical goal of all patients. All patients were followed up from 3 to 84 months. Results Of 112 patients, 107 were achieved awake and alert during brain mapping and resection of the lesions, 99 were detectedthe motor areas by intra-operative direct electrical stimulation and 61 for language related cortex and 18 for sensory cortex. Of 112 patients,66 received totally resection of lesions,34 subtotal and 12 partial. 37 patients had transitory post-operative paralysis, 26 with transitory post-operative aphasia and 3 with permanent neurological sequelae. No patient died of surgery or complaint of pain recollection following operation. Conclusions Awake anesthesia, intra-operative DES and sonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgical resection of lesions on eloquent areas.

关 键 词：脑胶质瘤 脑功能区 直接电刺激 唤醒麻醉 超声 

分 类 号：R739.4[医药卫生—肿瘤]