天津医药

• 论著 •    

全麻唤醒和术中神经电生理技术在涉及语言功能区癫痫手术中的应用

刘阳   

  1. 天津医科大学总医院
  • 收稿日期:2011-07-11 修回日期:2011-10-23 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 刘阳

Awaking anaesthesia and intraoperative neurophysiological techniques in epilepsy surgery involved in the language areas

  • Received:2011-07-11 Revised:2011-10-23 Published:2012-03-15 Online:2012-03-15

PDF (PC)

2007

摘要： 目的：探讨全麻唤醒和术中神经电生理技术在涉及语言功能区癫痫手术中的应用及其意义。方法：9例患者术前评估定位致痫病灶和（或）致痫灶和语言功能区及其关系，术中皮层电极（ECoG）监测痫性放电区，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的切除致痫病灶和（或）致痫灶，再次行ECoG监测，对仍有痫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痫控制情况。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例癫痫控制为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的处理涉及语言功能区的致痫病灶和（或）致痫灶及痫性放电区，降低语言功能损害的发生率，提高患者术后的生活质量。

关键词: 全麻唤醒, 术中电生理, 语言功能区, 癫痫, 手术

Abstract: Objective:To discuss the application of awaking anesthesia and neurophysiological techniques in epilepsy surgery involved in the language areas. Methods: The relationship between Epileptogenic lesions and (or) epileptogenic focus and the language areas were confirmed by preoperative assessments in 9 patients. Electrocardiography recordings were adopted to confirm the epileptiform discharge area, and then cortical electrical stimulation was performed to locate the language areas. According to the relationship between the language areas and epileptogenic lesions and (or) eileptogenic focus, we choose the appropriate surgical approach to protect the language areas and remove epileptogenic lesions and (or) eileptogenic focus. BCFC or MST has been used to deal with epileptiform discharge area. We evaluated language function and control of epilepsy postoperation.Results:There were 4 patients with language dysfunction after operations，and 3 of which was reversible within two weeks, but 1 patient was moderate motor aphasia. Patients were in a good control of epilepsy.7 patients were EngelⅠand 2 were EngelⅡ.Conclusion:Awaking anesthesia and intraoperative neurophysiological techniques were reliable and precise in epilepsy surgery involved in the language areas, which allow a maximum resection of the epileptogenic lesions and (or) epileptogenic focus and protection of language areas, which improve the life quality of patients.

Key words: Awaking anesthesia, Intraoperative electrophysiology, Language areas, Epilepsy, Operation