Stabell Kirsten E, Bakke Søren J, Andresen Sverre, Bjørnaes Helge, Borchgrevink Hans M, Due-Tønnessen Paulina, Heminghyt Einar, Nome Terje, Pedersen Hans-Kristian, Ramm-Pettersen Jon, Røste Geir K, Tennøe Bjørn
National Centre for Epilepsy, Sandvika, Norway.
Epilepsia. 2004 Jul;45(7):817-25. doi: 10.1111/j.0013-9580.2004.59903.x.
To evaluate the efficacy and risk of complications of selective posterior cerebral artery (PCA) amobarbital anesthesia in memory assessment of patients with epilepsy under consideration for temporal lobe resection.
Thirty-two candidates for temporal lobectomy in whom conclusive memory assessment could not be obtained by the standard intracarotid amobarbital procedure were submitted to a selective PCA amobarbital test. A mean dose of 75 mg amobarbital was injected via microcatheter into the P2 segment of the PCA. Ten common objects were presented for naming and remembering while the anesthesia was judged efficient. After return to neurologic baseline, recall and recognition memory were assessed.
In all of the 32 patients, angiography and PCA anesthesia were successfully accomplished without serious adverse events. All but one of the patients remained alert and cooperative for memory testing under the anesthesia, and 28 of these patients showed adequate memory capacity of the hemisphere contralateral to the side targeted for surgery. So far, 19 patients have proceeded to surgery, and no case of global amnesia or serious, material-specific memory impairment has resulted. Three patients failed the PCA test (fewer than 67% items correctly recognized) and were excluded from surgery, partly on the basis of the PCA test results, but also supported by an overall evaluation of all the diagnostic procedures used.
The selective PCA amobarbital test appears justifiable when performed by interventional neuroradiologists and may significantly reduce the risk of erroneously excluding patients with epilepsy from temporal resection. Further corroboration of the safety of the procedure seems warranted.
评估选择性大脑后动脉（PCA）异戊巴比妥麻醉在考虑行颞叶切除术的癫痫患者记忆评估中的疗效及并发症风险。
32例无法通过标准颈内动脉异戊巴比妥程序获得明确记忆评估结果的颞叶切除术候选患者接受了选择性PCA异戊巴比妥试验。通过微导管将平均剂量75mg的异戊巴比妥注入PCA的P2段。在判定麻醉有效时，呈现10个常见物品供命名和记忆。恢复到神经学基线状态后，评估回忆和识别记忆。
32例患者均成功完成血管造影和PCA麻醉，未发生严重不良事件。除1例患者外，所有患者在麻醉下对记忆测试保持清醒且配合，其中28例患者对手术侧对侧半球显示出足够的记忆能力。到目前为止，19例患者已接受手术，未出现全面性遗忘或严重的、特定材料记忆损害的病例。3例患者PCA试验未通过（正确识别的项目少于67%），被排除在手术之外，部分是基于PCA试验结果，但也得到了对所有使用的诊断程序的全面评估的支持。
由介入神经放射学家进行选择性PCA异戊巴比妥试验似乎是合理的，并且可能显著降低错误地将癫痫患者排除在颞叶切除术之外的风险。该程序安全性的进一步确证似乎是必要的。
