全麻唤醒和术中神经电生理技术在涉及语言功能区癫手术中的应用

目的:探讨全麻唤醒联合术中神经电生理技术在涉及语言功能区癫癎手术中的应用及其意义.方法:9例患者术前评估定位致癎病灶和(或)致癎灶和语言功能区及其关系,术中皮层电极(ECoG)监测癎性放电区,全麻唤醒下皮层电刺激(CES)定位语言功能区,在保护好语言功能区的前提下最大程度地切除致癎病灶和(或)致癎灶,再次行ECoG监测,对仍有癎性放电的区域行皮层热灼(BCFC)或多处软膜下横切(MST)直至ECoG监测满意为止,术后评估患者语言功能和癫癎控制情况.结果:9例患者中有1例术后第1天即出现程度不同的语言障碍并遗留部分运动性失语,3例在术后第2天出现语言障碍并于1周左右开始恢复,2周内恢复至术前.9例患者中7例癫癎控制为EngelⅠ,2例为EngelⅡ.结论:全麻唤醒和术中电生理技术应用有助于安全准确地处理涉及语言功能区的致癎病灶和(或)致癎灶及癎性放电区,降低语言功能损害的发生率,提高患者术后的生活质量.

Awaking Anesthesia and Intraoperative Neurophysiological Techniques in Epilepsy Surgery Involved in Language Areas

Objective: To discuss the application of awaking anesthesia and neurophysiological techniques in epilepsy surgery involved in language areas. Methods: The epileptogenic lesions and the relationship between epileptogenic focus and language areas were estimated and confirmed by preoperative assessments in 9 patients. Electrocardiography recordings were adopted to confirm the epileptiform discharge area, and then cortical electrical stimulation(CES)was performed to locate the language areas. According to the relationship between language areas and epileptogenic lesions and (or) eileptogenic focus, the appropriate surgical approach was chosen to protect the language areas and remove epileptogenic lesions and (or) eileptogenic focus. The bipolar coagulation on functional cortex(BCFC) or multiple subpial transection(MST) was used to deal with epileptiform discharge area. The language function and epileptic control were estimated after surgery. Results: In 9 patients, there were 4 patients with language dysfunction after operations,in which 1 patient appeared language dysfunction and moderate motor aphasia 1 d after surgery, 3 patients appeared language dysfunction 2 d after surgery and recovery occurred in one week, the dysfunction returned to the normal state in two weeks. Epilepsy control was EngelⅠin 7 of 9 patients, and 2 were EngelⅡ. Conclusion: Awaking anesthesia and intraoperative neurophysiological techniques were reliable and precise in epilepsy surgery involved in the language areas, which allowed a maximum resection of the epileptogenic lesions and (or) epileptogenic focus and improved the life quality of patients.