USE OF STIMULATION MAPPING AND CORTICOGRAPHY IN THE EXCISION OF ARTERIOVENOUS-MALFORMATIONS IN SENSORIMOTOR AND LANGUAGE-RELATED NEOCORTEX
USE OF STIMULATION MAPPING AND CORTICOGRAPHY IN THE EXCISION OF ARTERIOVENOUS-MALFORMATIONS IN SENSORIMOTOR AND LANGUAGE-RELATED NEOCORTEX
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DOI：
10.1227/00006123-198903000-00002
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发表时间：
1989-03-01
期刊：
影响因子：
4.8
通讯作者：
WINN, HR
中科院分区：
文献类型：
--
作者：
BURCHIEL, KJ;CLARKE, H;WINN, HR
位于雄辩新皮质内的动静脉畸形（AVM）的切除提出了巨大的神经外科挑战。正常周围大脑的血管供应受损或对重要的邻近新皮质的手术创伤可能会导致不可接受的术后神经发病率。此外，在没有术中皮质造影的情况下成功切除这些病变可能会留下高度致癫痫的大脑原位区域，导致持续的癫痫。在本报告中，我们描述了 8 名在我们机构接受开颅手术和动静脉畸形切除术的患者。其中六个病变位于优势（左）半球，两个位于右侧。所有患者均接受了通过颈动脉注射 Amytal 的术前测试（Wada 测试）。随后，患者接受了局部麻醉，我们进行了开颅手术。皮质电图用于识别 AVM 区域的致癫痫脑并建立电刺激的放电后阈值。然后使用刺激映射技术来描绘关键的运动、感觉和语言区域。还进行了喂养血管的试验闭塞，以记录闭塞后神经功能恶化（如果有）。随后，在全身麻醉下进行第二次手术，使用之前获得的皮质图切除病变和任何致痫灶。使用这些技术，可以在八名患者中的七名中完全切除这些病变，而不会造成额外的神经功能缺损。
The excision of an arteriovenous malformation (AVM) located within eloquent neocortex presents a formidable neurosurgical challenge. Compromise of the vascular supply to normal surrounding brain or surgical trauma to essential neighboring neocortex may result in unacceptable postoperative neurological morbidity. In addition, successful removal of these lesions without the benefit of intraoperative corticography may leave in situ areas of highly epileptogenic brain, resulting in continued epilepsy. In this report, we describe eight patients who underwent craniotomy and excision of AVMs at our institutions. Six of these lesions were located in the dominant (left) hemisphere, and two were on the right. All patients underwent preoperative testing with Amytal administered via the carotid artery (Wada test). Subsequently, the patient was placed under local anesthesia, and we performed a craniotomy. Electrocorticography was used to identify epileptogenic brain in the region of the AVM and to establish after-discharge thresholds to electrical stimulation. Stimulation-mapping techniques were then used to delineate critical motor, sensory, and language areas. Trial occlusion of feeding vessels was also carried out to document postocclusion neurological deterioration, if any. At a later time, a second procedure was performed under general anesthesia to excise the lesion and any epiletogenic foci, using the cortical maps derived earlier. Using these techniques, it was possible to effect complete excision of these lesions in seven of eight patients without causing additional neurological deficits.