术中直接皮质电刺激在功能区胶质瘤手术中的应用  

Intraoperative direct electrical stimulations of central nervous system during surgery of gliomas near eloquent areas

作　　者：王伟民[1] 白红民[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

出　　处：《中国现代神经疾病杂志》2012年第6期691-695,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：军队临床高新技术重大项目(项目编号:2010Gxjs033)~~

摘　　要：目的探讨直接电刺激在脑功能区胶质瘤手术中的应用方法和临床意义。方法对2003年1月-2012年1月接受大脑功能区胶质瘤手术中行功能区直接电刺激的157例患者的临床资料进行回顾总结。结果术中经皮质电刺激4例呈阴性,其余153例分别刺激出运动功能区皮质(139例)、感觉功能区皮质(21例)和语言相关功能区皮质(91例);计数中断阳性区域主要位于左侧中央前回下方、额下回盖部、额下回三角部、额中回后部和额上回后部。术后MRI显示全切除92例(58.60%)、次全切除55例(35.03%)、部分切除10例(6.37%)。术后病理证实:低级别胶质瘤共110例(70.06%),包括星形细胞瘤71例、少突胶质细胞瘤26例和少突星形细胞瘤13例;高级别胶质瘤47例(29.94%),分别为胶质母细胞瘤19例、间变性星形细胞瘤15例和间变性少突胶质细胞瘤13例。术后53例(33.76%)出现短暂性肢体运动障碍、39例(24.84%)出现短暂性语言功能障碍,仅4例(2.55%)发生永久性神经功能障碍。结论皮质电刺激技术是一种可靠无创的脑功能区定位方法,用于脑胶质瘤外科手术可最大程度并安全切除肿瘤。Objective To report our experiences of direct cortical stimulation in surgery of gliomas located in eloquent areas. Methods Clinical data of 157 patients with gliomas underwent awake craniotomy with the direct electrical stimulation for functional mapping of the eloquent areas were analysed retrospectively. Results Negative cortical stimulation was found in 4 patients, and positive cortical stimulation was achieved in 153 patients （97.45%）. Four hundred and ninty-six cortical sites in 139 patients were detected for motor response by direct electrical stimulation, 70 sites in 21 patients for sensory, 112 sites in 91 patients for language （such as counting and naming）. The positive areas of counting disturbance were mainly seen at the lower part of left precentral gyri operculum of left inferior frontal gyri, triangular part of left inferior frontal gyri, posterior part of left middle frontal gyri, and posterior part of left superior frontal gyri. Postoperative MRI showed 92 patients （58.60%） achieved total resection, 55 cases （35.03%） subtotal and 10 cases （6.37%） partial. One hundred and ten patients （70.06%） were diagnosed as having low grade glimas, including 71 cases of astrocytoma, 26 cases of oligodendroglioma, and 13 cases of mixed astro- oligodendroglioma, 47 patients （29.94%） were high grade gliomas, including 19 eases of glioblastoma, 15 eases of anaplastic astrocytoma, and 13 eases of anaplastic oligodendroglioma. After operation 53 patients （33.76%） occurred transient postoperative paralysis, 39 patients （24.84%） transient language disturbance and 4 patients （2.55%） permanent neurological deficits. Conclusion Intraoperative direct electrical stimulation is a reliable, precise and safety method for functional mapping of the eloquent areas. This technique allows us to achieve ＂maximal safety resection＂ in glioma surgery.

关 键 词：大脑皮质 电刺激 神经胶质瘤 监测 手术中 麻醉 静脉 清醒镇静 

分 类 号：R739.4[医药卫生—肿瘤]