Neurosurgery Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 09807, Hospitalet de Llobregat, Barcelona, Spain.
Neurophysiology Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 09807, Hospitalet de Llobregat, Barcelona, Spain.
Acta Neurochir (Wien). 2018 Oct;160(10):1963-1974. doi: 10.1007/s00701-018-3644-3. Epub 2018 Aug 8.
Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas.
Twenty patients harboring cavernous malformations located in supratentorial eloquent areas were surgically treated. Individualized functional approach, using intraoperative brain mapping and/or neurophysiological monitoring, was utilized in each case. Eleven patients underwent surgery under awake conditions; meanwhile, nine patients underwent asleep surgery.
Total resection was achieved in 19 cases (95%). In one patient, the resection was not possible due to high motor functional parenchyma surrounding the lesion tested by direct cortical stimulation. Ten (50%) patients presented transient neurological worsening. All of them achieved total neurological recovery within the first year of follow-up. Among the patients who presented seizures, 85% achieved seizure-free status during follow-up. No major complications occurred.
Intraoperative electric brain stimulation techniques applied by a trained multidisciplinary team provide a valuable aid for the treatment of certain cavernous malformations. Our results suggest that tailored functional approach could help surgeons in adapting surgical strategies to prevent patients' permanent neurological damage.
随着术中神经生理监测和脑图谱技术的发展，功能区手术已变得更加安全。然而，术中电脑刺激技术在幕上功能区海绵状血管畸形的管理和手术治疗中的应用价值仍未得到证实。通过本研究，我们旨在描述我们使用定制的功能方法治疗幕上功能区海绵状血管畸形的经验。
20 例位于幕上功能区的海绵状血管畸形患者接受了手术治疗。在每种情况下，均采用个体化的功能方法，使用术中脑图谱和/或神经生理监测。11 例患者在清醒状态下接受手术，而 9 例患者则在睡眠状态下接受手术。
19 例（95%）患者实现了完全切除。1 例患者由于病变周围的运动功能实质（通过直接皮质刺激测试）较高，无法进行切除。10 例（50%）患者出现短暂性神经功能恶化。所有患者在随访的第一年均完全恢复神经功能。在出现癫痫发作的患者中，85%在随访期间达到无癫痫发作状态。未发生重大并发症。
经过训练的多学科团队应用术中电脑刺激技术为某些海绵状血管畸形的治疗提供了有价值的辅助手段。我们的结果表明，定制的功能方法可以帮助外科医生调整手术策略，以防止患者出现永久性神经功能损伤。
