术中唤醒麻醉结合定位技术切除脑深部病灶的临床研究  

Clinical analysis of resection of deep brain lesions by using awake anesthesia and multiple positioning technology

作　　者：周辉 鲁明 邓心情 邓星海 

机构地区：[1]广东三九脑科医院神经外五科,广州510510

出　　处：《中华神经医学杂志》2015年第8期835-838,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨术中唤醒麻醉状态下结合多种定位技术切除脑深部病灶的安全性和临床疗效。方法对广东三九脑科医院神经外科自2013年9月至2014年9月应用显微外科手术治疗的77例脑深部病灶患者，经全麻下开颅，术中唤醒患者，在其清醒状态下通过神经影像导航技术确定病灶的位置与边界，皮层体感诱发电位或皮层电刺激方法进行语言、运动等脑功能区定位，在保护好脑功能区的前提下切除脑深部病灶，并随访3个月。结果74例患者唤醒良好。术中有8例定位出语言相关的功能区，38例定位出运动功能区皮层。病灶全切除51例，次全切除24例，部分切除2例。术后发生短暂偏瘫、运动功能障碍10例，语言障碍2例。结论术中唤醒麻醉状态下结合神经影像导航技术确定病灶边界及皮层电生理监测定位语言、运动功能区，可以有效保护患者脑功能，最大程度地切除病灶并提高手术疗效及患者术后生存质量。Objective To investigate the surgical safety and clinical efficacy of resection of deep brain lesions by using awake anesthesia and multiple positioning technology. Methods A retrospective analysis of clinical data and surgical treatments of 77 patients with deep brain lesions, admitted to our hospital from September 2013 and September 2014, was performed. Craniotomy was performed under general anesthesia, and then, awaking up of patient during surgery was achieved. Under awake state, the boundary of the lesions was mapped by neuroimage navigation technology, and language and movement functional areas were located using direct cortex evoked potential or cortical electrical stimulation. The deep brain lesions were removed according to anatomic-fimctional boundaries. Patients were followed up for 3 months. Results Intra-operative awaking up was successful in 74 patients. Language areas were identified in 8 patients, and movement fimctional areas were detected in 38 patients. Total resection was achieved in 51 patients, sub-total resection in 24 and 2 partial removals. Postoperative temporary movement barriers were noted in 10 patients and language barriers in 2 patients. Conclusion The deep brain lesions can be maximally removed by combined neuroimage navigation with cortical electrical stimulate under awake anesthesia, which can significantly protect the important brain functions and improve the quality of patients life after surgery.

关 键 词：脑深部病灶 唤醒麻醉 神经影像导航 皮层电生理监测 

分 类 号：R614[医药卫生—麻醉学]