Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Curr Opin Anaesthesiol. 2012 Oct;25(5):533-9. doi: 10.1097/ACO.0b013e32835774d4.
This review highlights recent advances in epilepsy surgery specifically awake surgery technique, and introduces the clinical application of neuromodulation concept in this field.
Surgical success, improving quality-of-life in epilepsy patients, relies upon complete resection of epileptogenic areas and perfect protection of functional areas. As there is no single way to define these areas directly, invasive evaluations will be necessary in addition to conventional noninvasive ones. The optimal anesthetic management with awake surgery technique should provide favorable working conditions for the surgeons and the neurologists without compromising the safety and comfort of the patient.New methods of controlling epilepsy, based on the concept of neuromodulation, have been recently introduced. Some positive results of these new techniques, such as DBS and RNS, might lay the foundation for expansion of implantation surgery.
Although the final goal of epilepsy surgery is the same in most cases, -that is, maximizing normal neurological function while minimizing adverse effects, the clinical approach differs for each patient. Therefore, advancement of a new approach to identify the epileptogenic areas and new surgical treatment option would be greatly beneficial for patients with intractable epilepsy.
本文重点介绍了癫痫手术领域的最新进展，特别是术中唤醒技术，并介绍了神经调控概念在该领域的临床应用。
癫痫手术的成功、提高癫痫患者的生活质量，依赖于致痫区的完全切除和功能区的完美保护。由于无法直接定义这些区域，因此除了常规的无创评估外，还需要进行有创评估。术中唤醒技术的最佳麻醉管理应为外科医生和神经科医生提供有利的工作条件，同时不影响患者的安全和舒适度。最近引入了一些基于神经调控概念的新的癫痫控制方法。这些新技术（如 DBS 和 RNS）的一些积极结果可能为植入手术的扩展奠定基础。
尽管大多数情况下癫痫手术的最终目标是相同的，即最大限度地提高正常神经功能，同时最大限度地减少不良反应，但每个患者的临床方法都不同。因此，为那些患有难治性癫痫的患者寻找新的致痫区识别方法和新的手术治疗方案将是非常有益的。
