Schatlo Bawarjan, Jägersberg Max, Paass Gerhard, Faltermeier Rupert, Streich Jörg, Meyer Bernhard, Schaller Karl
1 Faculty of Medicine, Department of Neurosurgery, Geneva University Hospital , Geneva, Switzerland.
Neurol Res. 2015;37(12):1037-46. doi: 10.1080/01616412.2015.1114287.
The aim of this study was to assess (1) whether vasoreactivity is altered in patients with epilepsy and (2) whether the two most commonly used approaches, the trans-Sylvian (TS) and the trans-cortical (TC) route, differ in their impact on cortical blood flow.
Patients were randomized to undergo selective amygdalohippocampectomy (selAH) through a TC or TS route. Before and after selAH, we recorded microcirculation parameters on the superficial cortex surrounding the surgical corridor. Blood flow and velocity were measured using laser Doppler flowmetry and micro-Doppler, respectively. Cortical oxygen saturation (SO2) was measured using remission spectrophotometry under hypocapnic and normocapnic conditions.
Ten patients were operated using the TS approach, and eight were operated via the TC approach. Vasomotor reactivity patterns measured with micro-Doppler were physiologically prior to selAH in both groups. After completion of surgery, a significant increase in SO2-values occurred in the TS group (before: 56.7 ± 2.2, after: 65.5 ± 3.0%SO2), but not in the TC group (before: 52.9 ± 5.2, after: 53.0 ± 3.7%SO2). The rate of critical SO2 values below 25% was significantly higher after the TC approach (12.3%) compared to the TS approach (5.2%; p < 0.05).
Our findings provide the first invasively measured evidence that patients with mesial temporal lobe epilepsy have preserved cerebral blood flow responses to alterations in CO2. In addition, local cortical SO2 was higher in the TS group than in the TC group after selAH. This may be a sign of reactive cortical vessel dilation after proximal vessel manipulation associated with the TS approach. In contrast, the lower values of SO2 after the TC approach indicate tissue ischaemia surrounding the surgical corridor surrounding the corticotomy.
本研究旨在评估（1）癫痫患者的血管反应性是否改变，以及（2）两种最常用的入路，即经侧裂（TS）和经皮质（TC）入路，对皮质血流的影响是否不同。
将患者随机分为通过TC或TS入路进行选择性杏仁核海马切除术（selAH）。在selAH前后，我们记录了手术通道周围浅表皮质的微循环参数。分别使用激光多普勒血流仪和微型多普勒测量血流和速度。在低碳酸血症和正常碳酸血症条件下，使用反射分光光度法测量皮质氧饱和度（SO2）。
10例患者采用TS入路进行手术，8例采用TC入路进行手术。两组在selAH前，用微型多普勒测量的血管运动反应模式均符合生理情况。手术完成后，TS组的SO2值显著升高（术前：56.7±2.2，术后：65.5±3.0%SO2），而TC组未升高（术前：52.9±5.2，术后：53.0±3.7%SO2）。TC入路后低于25%的临界SO2值发生率（12.
