术中全麻唤醒下定位切除脑功能区病变(附5例报告)  

Surgery of lesions in eloquent areas by functional mapping under awaking anaesthesia:clinical report of five cases

作　　者：王伟民[1] 施冲[2] 李天栋[1] 蒋小星[1] 白红民[1] 高寒[1] 王国良[1] 李建亭[1] 王玉宝[1] 

机构地区：[1]中国人民解放军广州军区广州总医院神经外科,广东广州510010 [2]中国人民解放军广州军区广州总医院麻醉科,广东广州510010

出　　处：《中国微侵袭神经外科杂志》2003年第6期245-249,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的初步探讨全麻唤醒状态下定位切除脑功能区病变的方法,为深入研究脑功能区微创手术提供经验。方法对5例脑功能区脑内占位病变病人进行喉罩插管、全麻下神经导航解剖定位开颅,术中麻醉唤醒,在清醒状态下,通过皮质诱发电位及皮质电刺激等方法进行脑功能区定位,在保护脑功能区的前题下切除脑内病变后再在全麻下关颅。结果5例病人均顺利经过喉罩插管下全麻-术中唤醒-再全麻,其中3例安全经历术中拔管和再插管。唤醒后脑功能区经采用神经电生理技术得到定位,脑内病变得到最大程度切除,无术后神经功能障碍发生,术前神经功能障碍均明显恢复,其中3例功能完全恢复正常。无手术并发症,病人术后无痛苦回忆。1例术前频繁发作癫者唤醒后出现癫发作。结论全麻唤醒状态下进行皮质电刺激及皮质诱发电位定位脑功能区手术有助于最大程度地切除脑功能区病灶,提高病人术后生存质量。Objective To study the method of functional mapping for eloquent areas under awaking anaesthesia for surgery of lesions in the cerebral eloquent areas. Methods 5 patients with lesions in the eloquent areas were undergone awaking surgery assisted with neuron-navigation system and functional mapping under awaking anaesthesia. Results 5 patients successfully underwent craniotomy under anaethesia with larynx mask and intravenous propofol, the identify of the functional areas and surgical resection of lesions under awaking, and close the cranium under re-anaesthesia during the operation, including 3 cases with pulling out larynx mask, then inserting it during awaking surgery. There is no deterioration of neurofunction after operation. The preoperative dysfunction were improved in all patients, and totally disappeared in three patients. Only one patient who suffered the frequently seizure underwent epileptic attack and no other complications occurred in awake operations. All patients have no painful experience in the operations. Conclusion Functional mapping for eloquent areas by somatosensory evoked potential and direct electrical stimulation under awaking anaesthesia is a reliable, precise and safe method, which allows a maximum resection of the lesions and protection of the normal function.

关 键 词：大脑功能区病变 手术治疗 神经外科 全麻唤醒状态 微创手术 手术定位 

分 类 号：R651.11[医药卫生—外科学]