术中全麻唤醒下定位切除脑功能区病变(附5例报告)

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一术中唤醒一再全麻，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例术前频繁发作癫痫唤醒后出现癫痫发作。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。

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

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.