Intra-operative direct electrical stimulations of the central nervous system: The Salpetriere experience with 60 patients
Intra-operative direct electrical stimulations of the central nervous system: The Salpetriere experience with 60 patients
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DOI：
10.1007/s007010050413
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发表时间：
1999-01-01
影响因子：
2.4
通讯作者：
Fohanno, D
中科院分区：
文献类型：
--
作者：
Duffau, H;Capelle, L;Fohanno, D
手术治疗中枢神经系统病变的指征取决于与切除受益相关的明确神经功能缺损的风险。由于个体差异较大，因此有必要检测功能区。神经成像功能技术正在发展，并开始有效的皮层感觉运动映射，但仍然缺乏敏感性和特异性的语言映射，并仍然无法在手术过程中提供实时数据，并进行皮层下映射。术中直接电刺激（DES）是更精确和可靠的功能映射方法，它可以识别和保存中枢神经系统（皮质-皮质下）每个水平的运动、感觉和语言的基本通路。我们报告了DES在幕上脑功能区肿瘤和血管畸形手术中的应用经验，从1996年11月至1999年5月，我们在La Salpetriere医院的科室连续对60例患者进行了全身或局部麻醉手术。其中37例临床表现正常，29例有轻度神经功能缺损。MRI显示幕上病变60例，其中优势半球中央前病变30例，中央后病变12例，侧裂周围病变14例，深部病变4例。所有受试者均使用DES进行手术切除，其中43例在全身麻醉下进行幕上皮质下皮质标测以检测运动区域，17例在局部麻醉下进行感觉运动和/或语言任务。最终病理诊断为胶质瘤44例（低级别31例，高级别13例），转移瘤9例，海绵状血管瘤3例，动静脉畸形（AVM）4例。全切除或次全切除52例（87%），部分切除8例（13%）。29例患者术后无功能缺损，而其他31例患者术后受损，除3例外，所有病例的完全恢复延迟了IS天至3个月（总发病率：5%）。中位随访时间为14个月，术中直接电刺激中枢神经系统是一种可靠、精确和安全的方法，可以实现功能映射，适用于功能区病变的所有手术。这种技术可以最大限度地减少术后神经功能缺损，同时提高切除质量。
Indications of surgical treatment for lesions in the central nervous system depend on the risk of a definitive neurological deficit, related to the benefit of resection. Detection of eloquent areas is then necessary because of major individual variability. Neuro-imaging functional techniques are in development and are beginning to be efficient for cortical sensorymotor mapping, but still lack sensitivity and specificity for language mapping, and remain unable to give realtime data during surgery and to perform sub-cortical mapping. The more precise and reliable method of functional mapping is represented by the intra-operative direct electrical stimulations (DES), which allow identification and preservation of essential pathways for motricity, sensibility and language, at each level of the central nervous system (cortico-subcortical). We report our experience of DES in the surgery of tumours and vascular malformations located in supratentorial brain eloquent areas, with a consecutive series of 60 patients operated on under general or local anaesthesia, from November 1996 until May 1999 in our department at La Salpetriere Hospital.Presenting symptoms in the 60 subjects (39 males, 21 females, mean age: 45 years) were seizures in 37 cases with normal clinical examination, and mild neurological deficit in 29 cases. MRI showed 60 supra-tentorial brain lesions: 30 precentral, 12 postcentral, 14 perisylvian in the dominant hemisphere, 4 deep-seated. All subjects underwent surgical resection using DES, with supratentorial corticosubcortical mapping under general anaesthesia for motor areas detection in 43 cases and under local anaesthesia for sensori-motor and/or language tasks in 17 cases. The final histological diagnosis was 44 gliomas (31 low-grade and 13 high-grade), 9 metastasis, 3 cavernomas, 4 arteriovenous malformations (AVM). Resection was total or subtotal in 52 cases (87%) and partial in 8 cases (13%). 29 patients had no post-operative deficit, while the other 31 patients were impaired post-operatively, with in all cases, except 3, a complete recovery delayed for IS days to 3 months (overall morbidity: 5%). The median follow up was 14 months.Intra-operative direct electrical stimulations of the central nervous system constitute a reliable, precise and safe method, allowing the realization of a functional mapping useful for all operations of lesions located in eloquent areas. This technique allows a minimization of definitive post-operative neurological deficit, and concurrently an improvement in the quality of resection.