Serletis Demitre, Bernstein Mark
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
J Neurosurg. 2007 Jul;107(1):1-6. doi: 10.3171/JNS-07/07/0001.
The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors.
The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%).
Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%).
Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.
作者前瞻性评估了在幕上肿瘤切除患者中无选择地使用清醒开颅手术的价值。
记录了610例行幕上肿瘤切除清醒开颅手术患者的人口统计学特征、症状表现、肿瘤位置、组织学诊断、结果及并发症。511例（83.8%）术中使用了脑图谱。脑图谱在115例患者（22.5%）中识别出明确的皮质功能区，在396例患者（77.5%）中未识别出明确的皮质功能区。
89例患者（14.6%）出现神经功能缺损。在进行脑图谱的511例患者亚组中，78例（15.3%）术后神经功能恶化。这种现象在术前有神经功能缺损的患者或脑图谱成功识别出明确功能组织的患者中更常见。511例患者中有25例（4.9%）术中发生癫痫，其中2例在全身性癫痫发作后需要插管并诱导全身麻醉。610例患者中有4例（0.7%）发生伤口并发症。7例患者（1.1%）出现术后血肿，其中4例急需再次开颅以清除血块。2例患者（0.3%）出院后不久需要再次入院。有3例死亡（0.5%）。
清醒开颅手术在切除不同病理范围和位置的幕上病变时安全、实用且有效。它允许术中脑图谱绘制，有助于识别和保护功能皮质。它还避免了全身麻醉诱导所固有的并发症。清醒开颅手术为已诱导全身麻醉的幕上脑病变患者提供了一种极佳的手术替代方案。
