Brain dysfunction following 'awake' craniotomy, brain mapping and resection of glioma
Brain dysfunction following 'awake' craniotomy, brain mapping and resection of glioma
复制标题
“清醒”开颅手术、脑部绘图和神经胶质瘤切除术后的脑功能障碍
DOI：
10.1080/0268869031000108873
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发表时间：
2003
影响因子：
1.1
通讯作者：
Nowreen Haq
中科院分区：
文献类型：
--
作者：
I. Whittle;S. Borthwick;Nowreen Haq
“清醒”切除脑肿瘤手术和脑标测的基本原理是，通过术中患者评估，肿瘤切除的数量得到优化，并将对邻近口才脑的损害风险降至最低。这两个目标大体上都达到了，但偶尔患者可能会有医源性术后缺陷。连续25例清醒开颅手术中描述了5例此类病例(20%)。这些患者分为三种不同的临床类型；那些(n=2)出现了术中发现的感觉-运动障碍；那些(n=2)出现了仅在术后测试中才明显的缺陷；以及一名患者在没有任何征兆的情况下突然出现了缺陷。前4名患者的缺陷在几周到几个月内恢复(16%)，但后一名患者(4%)留下严重的局灶性运动障碍。这些病例突出了清醒开颅手术和术中评估的优点和局限性。虽然感觉-运动障碍可以早期发现，但一些高水平的神经功能可能不容易在术中评估，血管灾难可能会在没有警告的情况下发生。讨论了这些医源性神经缺陷的病理生理学基础，以及减少此类问题的技术。
The rationale for 'awake' resective brain tumour surgery and brain mapping is that the amount of tumour removed is optimized, and risks of damage to adjacent eloquent brain minimized by intraoperative patient assessments. Both goals are generally attained, but occasionally patients may have iatrogenic postoperative deficits. Five such cases (20%) are described from a consecutive series of 25 awake craniotomies. These patient fell into three distinct clinical categories; those (n = 2) who developed sensory-motor deficits that were recognized intraoperatively; those (n = 2) who had deficits that were apparent only on postoperative testing; and one patient who developed a sudden deficit with no warning. The former four patients had deficits that recovered within weeks to months (16%), but the latter one (4%) was left with a severe focal motor disability. These cases highlight both the benefits and limitations of awake craniotomy and intraoperative assessment. Although sensory-motor deficits can be recognized early, some high-level neurological functions may not be readily assessed intraoperatively and vascular catastrophes may occur without warning. The pathophysiological basis of these iatrogenic neurological deficits, and techniques to minimize such problems are discussed.
影响因子：
4.1
作者：
OJEMANN, G;OJEMANN, J;BERGER, M
通讯作者：
BERGER, M