A device for cooling localized regions of human cerebral cortex - Technical note
A device for cooling localized regions of human cerebral cortex - Technical note
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DOI：
10.3171/jns.2003.99.3.0604
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发表时间：
2003-09-01
影响因子：
4.1
通讯作者：
Howard, MA
中科院分区：
文献类型：
--
作者：
Bakken, HE;Kawasaki, H;Howard, MA
神经外科医生在手术过程中使用侵入性标测方法来了解患者的功能性神经解剖结构。电刺激方法通常用于暂时破坏大脑皮层的病灶区域，以便外科医生可以推断被刺激的大脑部位的功能作用。尽管电刺激标测是一种有效且有用的方法，但其模式具有显著的局限性。神经科学家使用局灶性冷却对实验动物的皮质功能进行更可控的破坏，在这份报告中，作者描述了他们在接受神经外科手术的患者中使用器械实现相同目标的经验。冷却探头由带有热电偶和脑电图（EEG）记录触点的不锈钢腔组成。当冷却探头位于软脑膜表面时，通过将冷冻盐水注入腔室来实现主动冷却。在18名患者中进行了实验。温度梯度测量表明，探针下的整个灰质厚度被冷却到破坏局部突触活动的温度。在冷却过程中始终观察到自发和刺激诱发的EEG活动的统计学显著变化，提供了生理功能可逆性中断的明确证据。Broca区功能映射过程中的初步结果表明，冷却引起的暂时性神经功能缺损与电刺激引起的暂时性神经功能缺损之间存在质的差异。这些发现表明冷却探针作为神经外科研究工具的安全性和实用性。应进行额外的严格设计的研究，以关联冷却，电刺激和局灶性损伤的影响。
Neurosurgeons use invasive mapping methods during surgery to understand the functional neuroanatomy of patients. Electrical stimulation methods are used routinely for the temporary disruption of focal regions of cerebral cortex so that the surgeon may infer the functional role of the brain site being stimulated. Although it is an efficient and useful method, modes of electrical stimulation mapping have significant limitations. Neuroscientists use focal cooling to effect a more controlled disruption of cortical functions in experimental animals, and in this report, the authors describe their experience using a device to achieve this same objective in patients undergoing neurosurgery. The cooling probe consists of a stainless steel chamber with thermocouples and electroencephalography (EEG) recording contacts. Active cooling is achieved by infusing chilled saline into the chamber when the cooling probe is positioned on the pial surface. Experiments were performed in 18 patients. Temperature gradient measurements indicate that the entire thickness of gray matter under the probe is cooled to temperatures that disrupt local synaptic activity. Statistically significant changes in spontaneous and stimulus-evoked EEG activity were consistently observed during cooling, providing clear evidence of reversible disruption of physiological functions. Preliminary findings during functional mapping of the Broca area demonstrated qualitative differences between the temporary neurological deficits induced by cooling and those caused by electrical stimulation. These findings indicate the safety and utility of the cooling probe as a neurosurgical research tool. Additional rigorously designed studies should be undertaken to correlate the effects of cooling, electrical stimulation, and focal lesioning.