Minimalism through intraoperative functional mapping.
Minimalism through intraoperative functional mapping.
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发表时间：
1996
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通讯作者：
M. Berger
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作者：
M. Berger
术中刺激标测可用于避免对辅助语言和感觉运动通路的功能区域造成不必要的风险。根据这里提供的数据，语言定位在整个人群中是可变的，只有负责运动言语的下额叶区域存在确定性。解剖标志，如颞叶语言区的前颞尖和额叶语言区的外侧蝶骨翼的后面是不可靠的，以避免术后失语症。因此，个人映射，以确定必要的语言网站有最大的可能性，避免永久性缺陷的命名，阅读，和运动语言。在类似的方法中，来自皮层和底层白色物质的运动和感觉通路可以在清醒和睡眠的患者中可靠地刺激和映射。虽然这些技术需要额外的手术时间和设备名义上的价格，结果往往是令人满意的，因为术后发病率已大大降低的过程中，这些手术策略。无论是否使用抗癫痫药物，患者的生活质量在癫痫控制方面都得到改善。这避免了必须进行第二次昂贵的手术程序，这是常规的，当手术外刺激和记录是通过硬膜下网格完成。此外，在初次手术时进行积极的肿瘤切除延长了肿瘤复发的时间，并且通常避免了随后再次手术的需要。因此，术中功能标测可以最好地暗示为导致“长期最小化”的手术技术。
Intraoperative stimulation mapping may be used to avoid unnecessary risk to functional regions subserving language and sensori-motor pathways. Based on the data presented here, language localization is variable in the entire population, with only certainty existing for the inferior frontal region responsible for motor speech. Anatomical landmarks such as the anterior temporal tip for temporal lobe language sites and the posterior aspect of the lateral sphenoid wing for the frontal lobe language zones are unreliable in avoiding postoperative aphasias. Thus, individual mapping to identify essential language sites has the greatest likelihood of avoiding permanent deficits in naming, reading, and motor speech. In a similar approach, motor and sensory pathways from the cortex and underlying white matter may be reliably stimulated and mapped in both awake and asleep patients. Although these techniques require an additional operative time and equipment nominally priced, the result is often gratifying, as postoperative morbidity has been greatly reduced in the process of incorporating these surgical strategies. The patients quality of life is improved in terms of seizure control, with or without antiepileptic drugs. This avoids having to perform a second costly operative procedure, which is routinely done when extraoperative stimulation and recording is done via subdural grids. In addition, an aggressive tumor resection at the initial operation lengthens the time to tumor recurrence and often obviates the need for a subsequent reoperation. Thus, intraoperative functional mapping may be best alluded to as a surgical technique that results in "minimalism in the long term".