[Tumor surgery of the speech cortex in local anesthesia. Neuropsychological and neurophysiological monitoring during operations in the dominant hemisphere].
[Tumor surgery of the speech cortex in local anesthesia. Neuropsychological and neurophysiological monitoring during operations in the dominant hemisphere].
复制标题
[局部麻醉下言语皮层肿瘤手术。
DOI：
10.1007/s001150050199
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
K. Bise
中科院分区：
文献类型：
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作者：
H. Reulen;U. Schmid;J. Ilmberger;W. Eisner;K. Bise
我们报告了 30 例病例，其中我们使用皮质刺激标测来定义局部麻醉下代表感觉运动、语言和言语功能的区域，以便于切除这些区域附近的占位性病变。根据布罗卡区位于额叶盖（额下回）和韦尼克区位于后周侧裂区（颞上回、角回和边缘上回）的简单概念，我们发现在 15 名患者的多达 4 个刺激部位中，语言和言语功能在这些区域之外表现出来。因此，皮质刺激标测的结果对于决定位于皮质下的病变的最佳进入路线以及神经胶质瘤的最佳切除平面至关重要。分别通过刺激标测和术中显微镜涂片制备确定这些区域和病变的界限后，在持续监测感觉运动、语言和言语功能的情况下安全地去除病变。手术后立即，我们发现 9 名患者 (30%) 出现语言和言语缺陷，其中 5 例完全解决，4 例不完全解决。因此，在随访期结束时，26 名患者 (87%) 的语言功能正常。结论是，使用该技术可以安全且广泛地切除病变，否则这些病变将被认为是危险的或不可切除的。
We report on 30 cases where we have used cortical stimulation mapping to define the areas representing sensorimotor, language and speech functions under local anesthesia to facilitate resection of space-occupying lesions near these areas. Under the simplistic concept that Broca’s area lies in the frontal operculum (inferior frontal gyrus) and that Wernicke’s area is located in the posterior perisylvian area (superior temporal, angular and supramarginal gyri), we found language and speech function to be represented outside these areas in up to 4 stimulation sites of 15 patients. The results of cortical stimulation mapping were therefore essential to decide on the optimal access route to the lesions that were located subcortically and on the optimal resection plane in gliomas. After the limits of these areas and of the lesions had been established with stimulation mapping and with intrasurgical microscopic smear preparations, respectively, lesions were safely removed under continuous monitoring of sensorimotor, language and speech function. Immediately after surgery we encountered language and speech deficits in 9 patients (30%), which resolved completely in 5 and inclompletely in 4 instances. Thus, language functions were normal in 26 patients (87%) at the end of the follow-up period. It is concluded that use of this technique allows safe and extensive resection of lesions that would otherwise have been considered hazardous to remove or inexcisable.