经颈内动脉注射异丙酚行Wada试验的初步研究

目的对难以进行功能磁共振(fMRI)检查的难治性癫痫患者采用异丙酚进行Wada试验,探讨其测定语言优势半球及双侧半球的运动及记忆功能的安全性和有效性。方法首先常规记录脑电图(EEG)30 min,并持续进行监测;之后经股动脉插管至颈内动脉,行全脑血管数字减影(DSA)检查;然后在心电及血压监护下,向患侧颈内动脉以弹丸方式快速注射一定剂量的异丙酚,使对侧上肢肌力保持在3级以下,并进行标准化的语言及记忆功能测定;30 min后,经股动脉插管另一侧颈内动脉,以同样方式进行测定。结果共12例患者,2例为癫痫性脑病,10例为局灶性症状性癫痫。1例因DSA造影发现双侧大脑后交通动脉明显开放而中止Wada试验,其余11例均进行了Wada试验。在11例患者中,7例在注射异丙酚后出现不同程度的一过性不良反应,10例患者最终接受手术治疗,经随访术后均未出现明显的神经功能受损。结论经股动脉插管至颈内动脉,行脑血管DSA,之后采用弹丸注射方式给予异丙酚进行Wada试验,可以安全有效地对大脑半球的运动、语言及记忆功能进行测定。

Preliminary study on Wada test with bolus injection of propofol into intracarotid artery

Objective To test the safety and validity of propofol used in Wada test for the purpose of assaying language,motor and memory function in intractable epilepsy patients who could not accomplish fMRI.Methods After digital substraction angiography(DSA),a certain dose of propofol was bolusly injected through the catheter into intracarotid artery(ICA) and produced contralateral hemiplegia.When the contralateral upper limb strength was lower than grade 3,language and memory functions were evaluated.30 minutes later,the other side of carotid catheterization was executed as well as neuropsychological test.Video-electroencephalography(V-EEG) was recorded through the whole procedure.Results There were 9 male and 3 female patients with the age range of 4-24 years-old and average age of 15 years-old.2 of 12 were epileptic encephalopathy,10 focal symptomatic epilepsy.Except for one case with posterior communicating artery openness in DSA,the other 11 cases were accomplished Wada test.Among these 11 patients,7 showed transient side effects without serious complication after injection narcotic,and 10 were operated for epilepsy.None of the operated patients developed obvious neurological deficit at postsurgical following.Conclusion It is safe and valid to apply bolus injection of propofol into intracarotid artery in Wada test to evaluate the language,motor and memory function of the cerebrum.