摘要目的 探讨唤醒麻醉下结合术中皮层电刺激在脑功能区病变手术中的应用及其意义. 方法 对南京医科大学附属第一医院神经外科自2011年5月全2013年12月手术治疗的10例脑功能区病变患者,在术前利用神经影像学评估病灶位置,在神经导航下定位开颅,术中唤醒麻醉患者,并利用直接皮层电刺激确定功能区,在保护功能区的前提下全麻切除病灶. 结果 10例患者均行皮质运动区监测且全部监测到明确的运动反应,与皮层体感诱发电位监测到的中央前回位置相符;有5例患者病变在左侧大脑半球并同时行语言区电刺激,同样均获得相应的阳性区.10例患者中8例病灶全切除,2例次全切除.术后2例即出现语言障碍,在1周内开始恢复,3周后恢复至术前.3例术后肢体肌力较术前差,1周内开始恢复,3个月均恢复至术前.所有患者术后均无永久性语言障碍. 结论 唤醒麻醉下结合术中皮层电刺激有助于准确判断脑功能区及附近病变与脑功能区之间的位置关系,是一种可靠、精确、安全的脑功能区定位方法,能够有效地保护脑功能区并最大程度地切除病灶,极大地提高了患者术后生活质量.

abstractsObjective To explore the application of the awake anesthesia and intra-operative cortico-subcortical electro-stimulation in the surgery for patients with lesions in eloquent areas.Methods Retrospective analysis of 10 patients with lesions in eloquent area,admitted to our hospital from May 2011 to December 2013,was performed.Neuroimaging was used to assess the location of the lesions before surgery,neuron-navigation was used in the craniotomy,awake anesthesia and intra-operative cortico-subcortical electro-stimulation in the surgery of lesions in eloquent areas was performed; and then,total excision of the lesions was adopted.Results Specific motor response was monitored in all the 10 patients accepted cortico-subcortical electro-stimulation,which was matched with that from anterior central gyrus; 5 of them also performed electrophotoluminescence in the language area could be detected with positive reactions.In all 10 patients,total resection was achieved in 8 and subtotal excision in 2.Two patients had transient language dysfunction after operation and got improvement within one week,and recovered to the normal state in three weeks.Myodynamia transitorily decreased in 3 patients after operation and started recovery in one week and achieved the normal state in three month.Perpetual aphasis was noted in all the patients.Conclusion Awake anesthesia and intraoperative direct electrical stimulation were helpful to distinguish lesions from eloquent area,which is a reliable,precise,and safe eloquent area location method; maximum resection of the lesions and minimal damage to the eloquent area can be achieved and the life quality of patients can be improved.