Pallud J, Rigaux-Viode O, Corns R, Muto J, Lopez Lopez C, Mellerio C, Sauvageon X, Dezamis E
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
Neurochirurgie. 2017 Jun;63(3):164-174. doi: 10.1016/j.neuchi.2016.08.009. Epub 2017 Feb 2.
The aim of brain glioma surgery is to maximize the quality of resection, while minimizing the risk of sequelae. Due to the frequent location of gliomas near or within eloquent areas, owing to their infiltrative feature, and because of major interindividual variability, the anatomofunctional organization and connectivity must be studied individually. Therefore, to optimize the benefit-to-risk ratio of surgery, intraoperative functional mapping is extensively used.
This article aims at describing the rationale, indications and practical aspects of intraoperative direct electrical bipolar electrostimulation for cortical and subcortical mapping under awake conditions using the asleep-awake asleep anaesthetic protocol in the setting of cerebral gliomas. We will address the operative approach, including patient positioning, functional mapping resection strategy, anaesthetic conditions, as well as tips and pitfalls.
The intraoperative direct electrical bipolar electrostimulation enables: (i) to study the real-time individual cortical functional organization; (ii) to study the anatomofunctional subcortical connectivity along the resection; (iii) to tailor the resection according to individual corticosubcortical functional boundaries. This is an easy, accurate, reliable, well-tolerated and safe detection technique of both cortical and subcortical functionally essential structures during resection. It should be performed in the context of a standardized protocol involving members of both anaesthesiology and neurosurgery teams at neurosurgical centers specialized in surgical neuro-oncology.
Intraoperative direct electrical bipolar electrostimulation for cortical and subcortical mapping under awake conditions is currently considered the "gold standard" clinical tool for brain mapping during cerebral resection in neuro-oncology.
脑胶质瘤手术的目的是在将后遗症风险降至最低的同时，最大程度地提高切除质量。由于胶质瘤常常位于功能区附近或内部，具有浸润性特征，且个体差异较大，因此必须对解剖功能组织和连接性进行个体化研究。所以，为了优化手术的风险效益比，术中功能图谱被广泛应用。
本文旨在描述在脑胶质瘤手术中，采用“入睡-清醒-入睡”麻醉方案，在清醒状态下对皮质和皮质下进行术中直接电双极电刺激图谱绘制的原理、适应症及实际操作要点。我们将探讨手术入路，包括患者体位、功能图谱切除策略、麻醉条件以及注意事项和陷阱。
术中直接电双极电刺激能够：（i）研究实时个体化皮质功能组织；（ii）研究沿切除路径的解剖功能皮质下连接性；（iii）根据个体皮质-皮质下功能边界调整切除范围。这是一种在切除过程中对皮质和皮质下功能关键结构进行检测的简便、准确、可靠、耐受性良好且安全的技术。应在涉及神经外科肿瘤手术专业的神经外科中心的麻醉科和神经外科团队成员的标准化方案背景下进行。
清醒状态下对皮质和皮质下进行术中直接电双极电刺激图谱绘制，目前被认为是神经肿瘤学中脑切除术中脑图谱绘制的“金标准”临床工具。
