直接电刺激在功能区神经上皮肿瘤手术中的应用

目的探讨直接电刺激在功能区神经上皮肿瘤手术中应用的意义。方法对44例大脑功能区神经上皮肿瘤手术中应用直接电刺激的临床资料进行回顾性总结。结果所有病例均在充分保护功能区的前提下，最大程度切除肿瘤，其中39例术中定位出运动区，14例定位出语言功能区；肿瘤全切28例，次全切12例，部分切除4例。平均随访23．5个月，无病生存35例（79．5％），死亡6例（13．6％）。15例术后出现短暂性一侧肢体活动障碍，11例出现短暂语言功能障碍，1例术后遗留永久性肢体运动功能障碍。所有患者均无痛苦回忆。结论皮层电刺激是一种可靠无创的脑功能区定位方法，在神经上皮肿瘤手术中应用此技术可在有效保护脑功能的前提下最大限度地切除功能区病变。

Application of direct electrical stimulation in resection of neuroepithelial tumors located in eloquent areas

Objective To review our experience on the application of direct electrical stimulation in resection of neuroepithelial tumors located in supratentorial eloquent areas.Methods A total of 44 patients with supratentorial neuroepithelial tumors were operated under awake anesthesia with intraoperative direct electrical stimulation 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.Results A total of 39 patients were detected on the motor areas by intraoperative direct electrical stimulation and 14 patients on language related cortex. Total resection was achieved in 28 cases, subtotal in 12 cases and partial in 4 cases. The median follow-up was 23.5 months. A total of 35 patients survived without progression and 6 patients died. Among the 6 dead patients, 5 patients were diagnosed as glioblastomas. A total of 17 patients had no postoperative deficits, while 15 patients with transitory postoperative paralysis, 11 patients with transitory postoperative aphasia and one patient with permanent paralysis. No patient complained of pain in operation. Conclusion Intraoperative direct electrical stimulation is a reliable, precise and safe method for functional mapping of the eloquent areas. This technique allows a minimal postoperative neurological deficit and an improvement in the quality of resection.