全麻唤醒和术中电刺激在脑功能区病灶性癫痫手术中的应用

目的 探讨全麻唤醒和术中电刺激在脑功能区病灶性癫痫手术中的应用及意义.方法 对11例涉及脑功能区病灶性癫痫患者术前行MRI和头皮视频脑电图检查,其中6例行fMRI检查.全麻下手术,其中7例行食道咽腔导管插管全麻唤醒.术中皮层脑电图定位痫样放电皮层,皮层电刺激定位皮质功能区,根据病灶、致痫皮层和皮层功能区关系选择相应手术方式,在切除病灶时作皮层电刺激以保护皮质下功能传导束.结果 10例病灶全切除,1例次全切除.术后2例暂时性偏瘫.随访6～24月,患者无神经功能障碍,Kamofsky评分平均100分,使用1种抗癫痫药物,癫痫控制满意.结论 食道咽腔导管插管全麻唤醒屉一种安全、简便的麻醉唤醒方法;术中电刺激监测能够最大限度切除病灶,妥善处理致痫皮层,有效保护脑功能区,改善患者的生活质量.

Awaking anaesthesia and intraoperative cortico-subcortical electrostimulation in surgery for secondary epilepsy induced by lesions in cerebral eloquent regions

Objective To discuss the application of awaking anesthesia and intraoperative cortico-subcortical electrostimulation in the surgery for patients with secondary epilepsy induced by lesions in eloquent areas. Methods A total of 11 patients initiated with epileptic seizure were collected in our study. All patients were right-handed and 5 had neurological dysfunction, and the mean Karnofsky performance status (KPS) scores were 87. Skull MRI and long-term video-EEG monitoring were performed for all patients, and 6 of them got functional MRI. The surgeries were performed under intravenous anesthesia: 4 got trachea intubation and the other 7 were performed pharyngeal esophageal intubation under awaking anesthesia. Electrocorticographic recordings were adopted to confirm the epileptogenic zone, and then cortical electrical stimulus was performed to locate the cortical functional area. Under subcortical electrostimulation monitoring, we resected the lesions by the methods of focal cortical resection or multiple subpial transaction (MST) according to the relation between epileptogenic zone and functional cortex; during the resection, subcortical electrostimulation was adopted to protect the tracts lay in the sub-cortex. Results Total resection was achieved in 10 patients, and subtotal excision in 1. The epileptogenic zone was performed cortical resection or pia mater-fiber transverse amputation.Two cases got transient hemiparalysis after operation. Followed up for 6-20 months, none of the patients had neurologic deficit, and the average KPS scores were 100. Epilepsies were well-controlled using only one antiepileptic drug. Conclusion Pharyngeal esophageal intubation under awaking anesthesia is safe and convenient. With the monitoring of intraoperative cortico-subcortical electrostimulation, we can resect the lesions up to the hilt and protect the eloquent areas effectively, and improve the life quality of patients.