Department of Neurosurgery, Oulu University Hospital, University of Oulu, Oulu, Finland,
Acta Neurochir (Wien). 2013 Oct;155(10):1805-12. doi: 10.1007/s00701-013-1837-3. Epub 2013 Aug 18.
Results of awake craniotomy are compared to results of resections done under general anesthesia in patients operated with IMRI control. We hypothesized that stimulation of the cortex and white matter during awake surgery supplements IMRI control allowing for safer resection of eloquent brain area tumors.
The study group consisted of 20 consecutive patients undergoing awake craniotomy with IMRI control. Resection outcome of these patients was compared to a control group of 20 patients operated in the same IMRI suite but under general anesthesia without cortical stimulation. The control group was composed of those patients whose age, sex, tumor location, recurrence and histology best matched to patients in study group.
Cortical stimulation identified functional cortex in eight patients (40 %). Postoperatively the neurological condition in 16 patients (80 %) in the study group was unchanged or improved compared with 13 patients (65 %) in the control group. In both groups, three patients (15 %) had transient impairment symptoms. There was one patient (5 %) with permanent neurological impairment in the study group compared to four patients (20 %) in the control group. These differences between groups were not statistically significant. There was no surgical mortality in either group and the overall infection rate was 5 %. Mean operation time was 4 h 45 min in the study group and 3 h 15 min in the control group.
The study consisted of a limited patient series, but it implies that awake craniotomy with bipolar cortical stimulation may help to reduce the risk of postoperative impairment following resection of tumors located in or near speech and motor areas also under IMRI control.
在接受 IMRI 控制的手术患者中，与全身麻醉下进行的切除术相比，清醒开颅术的结果。我们假设在清醒手术过程中对皮质和白质进行刺激可补充 IMRI 控制，从而使语言和运动区附近的肿瘤更安全地切除。
研究组由 20 例连续接受 IMRI 控制下清醒开颅术的患者组成。将这些患者的切除结果与在同一 IMRI 套件中但在无皮质刺激下全身麻醉下进行手术的 20 例对照组患者进行比较。对照组由年龄、性别、肿瘤位置、复发和组织学与研究组患者最佳匹配的患者组成。
皮质刺激在 8 例患者（40％）中确定了功能皮质。术后，研究组 16 例患者（80％）的神经状况与对照组 13 例患者（65％）相比无变化或改善。在两组中，均有 3 例患者（15％）出现短暂的损害症状。研究组中有 1 例（5％）患者出现永久性神经损伤，对照组中有 4 例（20％）患者出现永久性神经损伤。两组之间的差异无统计学意义。两组均无手术死亡，总感染率为 5％。研究组的平均手术时间为 4 小时 45 分钟，对照组为 3 小时 15 分钟。
该研究病例数有限，但它表明在 IMRI 控制下，使用双极皮质刺激的清醒开颅术可能有助于降低位于或靠近言语和运动区的肿瘤切除术后损害的风险。
