Mukoyama Yoko, Ichikawa Junko, Komori Makiko, Kodaka Mitsuharu, Yokosako Suguru, Kubota Yuichi
Departments of Anesthesiology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan.
Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan.
JA Clin Rep. 2024 Sep 19;10(1):59. doi: 10.1186/s40981-024-00740-1.
During epilepsy surgery, it is equally important to record electrocorticography (ECoG) for detecting epileptogenic activity and guiding brain resection, and to evaluate neuromonitoring data, particularly motor evoked potentials (MEP), for avoidance of postoperative neurological complications. However, sevoflurane, which is commonly used during recording of ECoG, may attenuate the MEP response. It enforces anesthesiologists and neurosurgeons to select one anesthetic agent over another, facilitating either ECoG or MEP monitoring.
In the presented case of a 20-year-old man, who underwent surgery for temporal lobe epilepsy, a novel technique of neuroanesthesia was introduced, integrating initial induction of the total intravenous anesthesia (TIVA) with propofol (effect-site concentration, 2.3-3.0 μg/ml), its subsequent switching to sevoflurane (end-tidal concentration, 2.5%) for ECoG recording, and further change back to TIVA for MEP monitoring during brain resection.
Intraoperative switch of anesthetic agents according to specific intraoperative requirements may be useful for cases of brain surgery requiring both ECoG recordings and MEP monitoring.
在癫痫手术中，记录皮质脑电图（ECoG）以检测致痫活动并指导脑切除，以及评估神经监测数据，尤其是运动诱发电位（MEP）以避免术后神经并发症，两者同样重要。然而，在记录ECoG时常用的七氟醚可能会减弱MEP反应。这迫使麻醉医生和神经外科医生在不同麻醉剂之间做出选择，以利于ECoG或MEP监测。
在本病例中，一名20岁男性接受了颞叶癫痫手术，引入了一种新的神经麻醉技术，即先用丙泊酚进行全静脉麻醉（TIVA）诱导（效应室浓度为2.3 - 3.0μg/ml），随后切换至七氟醚（呼气末浓度为2.5%）进行ECoG记录，在脑切除期间再换回TIVA进行MEP监测。
根据术中特定需求进行麻醉剂的术中切换，对于需要同时进行ECoG记录和MEP监测的脑外科手术病例可能是有用的。
