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目的探讨切除脑功能区胶质瘤手术新技术与方法。方法 112例胶质瘤患者在术中全麻唤醒状态下,通过术中B超或神经导航定位病灶,直接电刺激定位脑功能区结构,并在清醒状态下切除病变。术后随访时间3～84个月。结果 107例唤醒良好,术中有99例定位出运动区,61例定位出语言相关的功能区皮质,18例定位出感觉区。病变全切66例,次全切除34例,部分切除12例。术后短暂性一侧肢体活动障碍37例,短暂的语言障碍26例,手术相关的永久性神经功能障碍3例,无手术死亡,全部患者术后无痛苦回忆。结论全麻术中唤醒技术、术中直接电刺激和术中脑超声技术是切除功能区胶质瘤的三项主要技术;综合使用这些技术能够在术中明确脑功能区与肿瘤的关系,做到最大限度地切除脑功能区病变和保护脑功能。
Objective To investigate the new technique and method of resection of glioma in brain functional area. Methods One hundred and twelve patients with glioma undergoing general anesthesia with intraoperative wakefulness were involved in the localization of brain functional areas through intraoperative ultrasound or neuroimaging. The structures of brain functional areas were directly electrostimulated and the lesions were removed under awake condition. The follow-up time was 3 to 84 months. Results A total of 107 patients awakened well. There were 99 cases located in the exercise area during operation. 61 cases localized the language-related functional cortex and 18 cases located the sensory area. 66 cases of complete lesion, subtotal resection in 34 cases, partial resection in 12 cases. There were 37 cases of transient limb movement disorder, 26 cases of transient language disturbance, 3 cases of surgery-related permanent neurological dysfunction, and no operative death. All patients had no painful memories after operation. Conclusion A total awakening technique, intraoperative direct electrical stimulation and intraoperative ultrasound are the three major techniques of resection of functional area glioma. Combining these techniques can clearly define the relationship between brain function area and tumor in operation To maximize the excision of brain function lesions and protect brain function.