Department of Neurosurgery, Liuhuaqiao Hospital, Guangzhou, Guangdong 510010, China.
Chin Med J (Engl). 2011 Oct;124(19):3035-41.
The goal of surgery in the treatment of intrinsic cerebral tumors is to resect the maximum tumor volume, and to spare the eloquent areas. However, it is difficult to discover the eloquent areas intraoperatively due to individual anatomo-functional variability both for sensori-motor and language functions. Consequently, the surgery of intrinsic cerebral tumors frequently results in poor extent of resection or permanent postoperative deficits, or both, and remains a difficult problem for neurosurgeons.
From January 2003 to January 2010, 112 patients with neuroepithelial tumors in/close to the eloquent areas were operated on under awake anesthesia with the intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The extent of the tumors was verified by intraoperative ultrasonography. The maximal resection of the tumors and minimal damage of the eloquent areas were the surgical goal of all patients.
Totally 356 cortical sites in 99 patients were detected for motor response by intraoperative direct electrical stimulation, 50 sites in 16 patients for sensory, 72 sites in 48 patients for language. Sixty-six patients (58.9%) achieved total resection, 34 (30.4%) subtotal and 12 (10.7%) partial. Fifty-eight patients (51.8%) had no postoperative deficit, while 37 patients (33.0%) had transitory postoperative paralysis, 26 patients (23.2%) with transitory postoperative language disturbance and 3 patients (2.7%) with permanent neurological deficits. No patient complained of pain recollection following operation.
Awake anesthesia, intraoperative direct electrical stimulation and ultrasonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgery for neuroepithelial tumors in/adjacent to eloquent areas.
在治疗颅内肿瘤时，手术的目标是最大限度地切除肿瘤，同时保护功能区。然而，由于感觉运动和语言功能的个体解剖功能变异性，术中很难发现功能区。因此，颅内肿瘤的手术常常导致切除范围不足或永久性术后缺陷，或者两者兼而有之，这对神经外科医生来说仍然是一个难题。
2003 年 1 月至 2010 年 1 月，112 例位于或靠近功能区的神经上皮肿瘤患者在全麻下行术中直接电刺激功能定位手术。应用术中超声验证肿瘤的范围。所有患者的手术目标是最大限度地切除肿瘤，最小限度地损伤功能区。
99 例患者中有 356 个皮质区（共 356 个皮质区）通过术中直接电刺激检测到运动反应，16 例患者中有 50 个区检测到感觉反应，48 例患者中有 72 个区检测到语言反应。66 例（58.9%）患者实现了肿瘤全切，34 例（30.4%）次全切，12 例（10.7%）部分切除。58 例（51.8%）患者术后无缺损，37 例（33.0%）患者术后出现暂时性瘫痪，26 例（23.2%）患者术后出现暂时性语言障碍，3 例（2.7%）患者出现永久性神经功能缺损。没有患者术后抱怨疼痛回忆。
全麻、术中直接电刺激和超声是切除靠近功能区的颅内肿瘤的三种核心技术。这一新概念提高了神经上皮肿瘤在功能区附近或毗邻部位的手术质量。
