Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
World Neurosurg. 2010 May;73(5):547-51. doi: 10.1016/j.wneu.2010.02.003.
Awake craniotomy and electrophysiologic mapping (EPM) is an established technique to facilitate the resection of near eloquent cortex. Intraoperative magnetic resonance imaging (iMRI) is increasingly used to aid in the resection of intracranial lesions. Standard draping protocols in high-field iMRI units make awake craniotomies challenging, and only two groups have previously reported combined EPM and high-field iMRI.
We present an illustrative case describing a simple technique for combining awake craniotomy and EPM with high-field iMRI. A movable platter is used to transfer the patient from the operating table to a transport trolley and into the adjacent MRI and still maintaining the patient's surgical position. This system allows excess drapes to be removed, facilitating awake craniotomy.
A 57-year-old right-handed man presented with new onset seizures. Magnetic resonance imaging demonstrated a large left temporal mass. The patient underwent an awake, left frontotemporal craniotomy. The EPM demonstrated a single critical area for speech in his inferior frontal gyrus. After an initial tumor debulking, the scalp flap was loosely approximated, the wound was covered with additional drapes, and the excess surrounding drapes were trimmed. An iMRI was obtained. The image-guidance system was re-registered and the patient was redraped. Additional resection was performed, allowing extensive removal of what proved to be an anaplastic astrocytoma. The patient tolerated this well without any new neurological deficits.
Standard protocols for positioning and draping in high-field iMRI units make awake craniotomies problematic. This straightforward technique for combined awake EPM and iMRI may facilitate safe removal of large lesions in eloquent cortex.
清醒开颅术和电生理图（EPM）是一种成熟的技术，可帮助切除接近语言功能区的皮质。术中磁共振成像（iMRI）越来越多地用于辅助颅内病变的切除。高场强 iMRI 单元中标准的铺巾方案使得清醒开颅术变得具有挑战性，只有两个小组之前曾报告过联合 EPM 和高场强 iMRI 的应用。
我们展示了一个案例，描述了一种将清醒开颅术和 EPM 与高场强 iMRI 结合的简单技术。使用可移动的托盘将患者从手术台转移到运输推车上，并进入相邻的 MRI 室，同时仍保持患者的手术体位。该系统允许移除多余的铺巾，便于进行清醒开颅术。
一名 57 岁的右利手男性因新发癫痫发作就诊。磁共振成像显示左侧颞叶有一个大肿块。患者接受了清醒的左额颞部开颅术。EPM 显示其下额回有一个单一的语言关键区。在初始肿瘤部分切除后，头皮瓣被松散地覆盖，切口用额外的铺巾覆盖，多余的周围铺巾被修剪。进行了 iMRI 检查。图像引导系统重新注册，患者重新铺巾。进行了进一步的切除，允许广泛切除证实为间变性星形细胞瘤的病变。患者耐受良好，没有出现新的神经功能缺损。
高场强 iMRI 单元中用于定位和铺巾的标准方案使得清醒开颅术变得复杂。这种联合清醒 EPM 和 iMRI 的简单技术可能有助于安全切除语言功能区的大型病变。
