Department of Neurosurgery, University Hospital "St. Ivan Rilski", Sofia, Bulgaria.
Department of Neurosurgery, University Hospital "St. Ivan Rilski", Sofia, Bulgaria.
World Neurosurg. 2021 Jul;151:e257-e264. doi: 10.1016/j.wneu.2021.04.021. Epub 2021 Apr 16.
Awake craniotomy (AC) and direct electric stimulation emerged together with epilepsy surgery >80 years ago. The goal of our study was to evaluate the benefits of awake surgery in patients with drug-resistant epilepsy caused by focal cortical dysplasia (FCD) affecting eloquent areas.
Our material included 95 patients with drug-resistant epilepsy and FCD, who were operated on between January 2009 and December 2018. These 95 patients were assigned into 3 groups: AC; general anesthesia (GA) with intraoperative neuromonitoring; and GA without intraoperative neuromonitoring. We investigated the following variables: age at surgery, lesion side, eloquent cortex involvement, brain mapping success rate, epilepsy surgery success rate, intraoperative complications, postoperative complications, and intraoperative changes of the preoperative resection plan according to results of the brain mapping by direct electric stimulation.
We found statistically significant differences between the AC and GA groups in the mean age at operation, lesion side, eloquent localization, and postoperative transient neurologic deficit. Seizure outcome in the AC was satisfactory (71% complete seizure control) and comparable to the seizure outcome in the GA groups. Our preoperative plan was changed because of functional constraints in 6 patients (43%) operated on during AC.
AC during epilepsy surgery for FCD in eloquent areas may change the preoperative plan. The good rate of postoperative seizure control and the absence of permanent postoperative neurologic deficit in our series is the main proof that AC is a useful tool in patients with FCD involving the eloquent cortex.
唤醒开颅术（AC）和直接电刺激与 80 多年前的癫痫手术同时出现。我们研究的目的是评估在因局灶性皮质发育不良（FCD）导致的药物难治性癫痫患者中，唤醒手术对影响语言区的益处。
我们的资料包括 95 例药物难治性癫痫和 FCD 患者，他们在 2009 年 1 月至 2018 年 12 月期间接受了手术。这 95 例患者分为 3 组：AC；术中神经监测的全身麻醉（GA）；和无术中神经监测的 GA。我们调查了以下变量：手术时的年龄、病变侧、语言区皮质受累、脑图绘制成功率、癫痫手术成功率、术中并发症、术后并发症以及根据直接电刺激的脑图绘制结果对术前切除计划的术中改变。
我们发现 AC 和 GA 组之间在手术时的平均年龄、病变侧、语言区定位和术后短暂性神经功能缺损方面存在统计学上的显著差异。AC 组的癫痫发作结果是令人满意的（71%完全控制发作），与 GA 组的癫痫发作结果相当。我们的术前计划在 6 例（43%）接受 AC 手术的患者中因功能限制而发生改变。
在语言区 FCD 的癫痫手术中进行 AC 可能会改变术前计划。我们系列中术后癫痫控制良好率和无永久性术后神经功能缺损是 AC 对涉及语言区的 FCD 患者是一种有用工具的主要证据。
