应用术中直接电刺激最大安全切除功能区胶质瘤  

Maximally safe resection of gliomas near eloquent areas through intra-operative direct electrical stimulation

作　　者：白红民[1] 王伟民[1] 李天栋[1] 林健[1] 高寒[1] 王丽敏[1] 夏丽慧[1] 谢学敏[1] 

机构地区：[1]广州军区广州总医院神经外科,510010

出　　处：《中华神经外科杂志》2012年第12期1210-1214,共5页Chinese Journal of Neurosurgery

基　　金：广东省自然科学基金（10151001002000010）;军队临床高新技术重大项目（2010Gxjs033）

摘　　要：目的探讨直接电刺激在功能区胶质瘤手术中应用的意义。方法回顾性分析157例大脑功能区胶质瘤术中直接电刺激的临床资料。结果皮质电刺激4例阴性刺激，139例刺激出运动区皮质，21例感觉区，91例出现语言相关区皮质。数数中断的阳性区主要位于左中央前回下方、左额下回盖部、左额下回三角部、左额中回后部和额上回后部。术后NRI示胶质瘤全切92例（58．6％），次全切55例，部分切除10例。术后53例出现短暂肢体运动障碍；39例出现短暂语言功能障碍，4例（2．5％）出现永久性神经功能障碍。结论术中直接电刺激是一种可靠无创的脑功能区定位方法，在胶质瘤手术中应用此技术可达到最大安全切除肿瘤，同时为国人功能区脑皮质定位提供帮助。Objective To report our experiences of direct electrical stimulation in surgery of gliomas near eloquent areas. Methods A retrospective analysis of the clinical data for 157 patients with supratentorial gliomas that underwent awake craniotomy, with direct electrical stimulation for functional mapping of eloquent areas, was performed. The maximal resection of tumors and the minimal damage of eloquent areas were the surgical goals of all patients. Results Negative cortical stimulation was found in four patients, and positive cortical stimulation was achieved in 153 patients （97. 5% ）. Additionally, 496 cortical sites in 139 patients were detected for motor response through direct electrical stimulation, 70 sites in 21 patients detected for sensory, and 112 sites in 91 patients detected for language （such as counting and naming）. In the 86 cortical sites for counting, 41 （47.7%） sites were located on the lower parts of the left precentral gyri, 21 on the left pars opercularis, 11 on the left pars triangularis, 9 on the posterior parts of the left middle frontal lobe, and 4 on the posterior part of the left superior frontal lobe. Post - operative MR showed that 92 patients （58. 6% ） achieved total resection; with 55 （35.0%） subtotal and 10 partial. Furthermore, 77 patients （49.0%） had no postoperative deficits; however, 53 patients （33.8%） had transitory post-operative paralysis, 39 patients （24. 8% ） had transitory language disturbances and 4 patients （2. 5% ） had permanent neurological deficits. Conclusions Intra- operative direct electrical stimulation is a reliable, precise, and safe method for functional mapping of the eloquent areas. This technique allows neurosurgeons to achieve maximally safe resectionin glioma surgery. It can also provide an important new way for Chinese brain mapping.

关 键 词：神经胶质瘤 脑定位 直接电刺激 唤醒开颅 

分 类 号：R739.4[医药卫生—肿瘤]