Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Clin Neurosci. 2011 Sep;18(9):1254-6. doi: 10.1016/j.jocn.2010.12.046. Epub 2011 Jul 7.
We report a patient with an infratentorial lesion resected under a far-lateral approach during awake craniotomy to optimize intraoperative monitoring. A 72-year-old man presented with falls, difficulty walking, and lower extremity weakness. MRI revealed a 2.2 by 2.3 by 2.8 cm mass at the right cervicomedullary junction, with mass effect on the adjacent spinal cord. During two attempts during surgical positioning under general anesthesia, motor evoked potentials were lost. Each time the operation was aborted. During the third operation, the patient underwent monitored, light anaesthesia and was awakened periodically to confirm conscious motor function. The operation proceeded without complication, and postoperatively there was no further decrease in motor function. This is, to our knowledge, the first use of an awake operation for an infratentorial meningioma via the far-lateral approach, demonstrating the technique may be used safely and can be useful in optimizing motor function monitoring.
我们报告了一例在清醒开颅术中通过远外侧入路切除颅后下病变以优化术中监测的患者。一名 72 岁男性因跌倒、行走困难和下肢无力就诊。MRI 显示右侧颈髓交界处有一个 2.2×2.3×2.8 cm 的肿块，对邻近脊髓有压迫效应。在全身麻醉下进行两次手术定位时，运动诱发电位消失。每次手术都被取消。第三次手术时，患者接受了监测下的轻度麻醉，并定期唤醒以确认有意识的运动功能。手术顺利进行，术后运动功能无进一步下降。据我们所知，这是首例通过远外侧入路对颅后下脑膜瘤进行清醒手术，表明该技术可以安全使用，并有助于优化运动功能监测。
