Nomura Sadahiro, Inoue Takao, Imoto Hirochika, Sadahiro Hirokazu, Sugimoto Kazutaka, Maruta Yuichi, Ishihara Hideyuki, Suzuki Michiyasu
Departments of Neurosurgery and.
Advanced Thermal Neurobiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
J Neurosurg Case Lessons. 2021 Jul 12;2(2):CASE21131. doi: 10.3171/CASE21131.
Functional mapping in awake craniotomy has the potential risk of electrical stimulation-related seizure. The authors have developed a novel mapping technique using a brain-cooling device. The cooling probe is cylindrical in shape with a thermoelectric cooling plate (10 × 10 mm) at the bottom. A proportional integration and differentiation-controlled system adjusts the temperature accurately (Japan patent no. P5688666). The authors used it in two patients with glioblastoma. Broca's area was identified by electrical stimulation, and then the cooling probe set at 5°C was attempted on it.
Electrocorticogram was suppressed, and the temperature dropped to 8°C in 50 sec. A positive aphasic reaction was reproduced on Broca's area at a latency of 7 sec. A negative reaction appeared on the adjacent cortices despite the temperature decrease. The sensitivity and specificity were 60% and 100%, respectively. No seizures or other adverse events related to the cooling were recognized, and no histological damage to the cooled cortex was observed.
The cooling probe suppressed topographical brain function selectively and reversibly. Awake functional mapping based on thermal neuromodulation technology could substitute or compensate for the conventional electrical mapping.
清醒开颅术中的功能定位存在电刺激相关癫痫发作的潜在风险。作者开发了一种使用脑冷却装置的新型定位技术。冷却探头呈圆柱形，底部有一个热电冷却板（10×10毫米）。一个比例积分微分控制系统可精确调节温度（日本专利号P5688666）。作者在两名胶质母细胞瘤患者中使用了该装置。通过电刺激确定了布罗卡区，然后尝试将设置为5°C的冷却探头置于该区。
皮层脑电图受到抑制，温度在50秒内降至8°C。在布罗卡区重现了阳性失语反应，潜伏期为7秒。尽管温度下降，但相邻皮层出现了阴性反应。敏感性和特异性分别为60%和100%。未发现与冷却相关的癫痫发作或其他不良事件，也未观察到冷却皮层的组织学损伤。
冷却探头选择性且可逆地抑制了局部脑功能。基于热神经调节技术的清醒功能定位可替代或补充传统的电定位。
