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Abstract：
To evaluate the applicability of corticocortical evoked potentials (CCEP) for intraoperative monitoring of the language network in epilepsy surgery under general anesthesia. To investigate the clinical relevance on language functions of intraoperative changes of CCEP recorded under these conditions.
CCEP monitoring was performed in 14 epileptic patients (6 females, 4 children) during resections in the left perisylvian region under general anesthesia. Electrode strips were placed on the anterior language area (AL) and posterior language area (PL), identified by structural and functional magnetic resonance imaging. Single-pulse electric stimulations were delivered to pairs of adjacent contacts in a bipolar fashion. During resection, we monitored the integrity of the dorsal language pathway by stimulating either AL by recording CCEP from PL or vice versa, depending on stability and reproducibility of CCEP. We evaluated the first negative (N1) component of CCEP before, during, and after resection.
All procedures were successfully completed without adverse events. The best response was obtained from AL during stimulation of PL in 8 patients and from PL during stimulation of AL in 6 patients. None of 12 patients with a postresection N1 amplitude decrease of 0%-15% from baseline presented postoperative language impairment. Decreases of 28% and 24%, respectively, of the N1 amplitude were observed in 2 patients who developed transient postoperative speech disturbances.
The application of CCEP monitoring is possible and safe in epilepsy surgery under general anesthesia. Putative AL and PL can be identified using noninvasive presurgical neuroimaging. Decrease of N1 amplitude >15% from baseline may predict postoperative language deficits.
CCEP monitoring was performed in 14 epileptic patients (6 females, 4 children) during resections in the left perisylvian region under general anesthesia. Electrode strips were placed on the anterior language area (AL) and posterior language area (PL), identified by structural and functional magnetic resonance imaging. Single-pulse electric stimulations were delivered to pairs of adjacent contacts in a bipolar fashion. During resection, we monitored the integrity of the dorsal language pathway by stimulating either AL by recording CCEP from PL or vice versa, depending on stability and reproducibility of CCEP. We evaluated the first negative (N1) component of CCEP before, during, and after resection.
All procedures were successfully completed without adverse events. The best response was obtained from AL during stimulation of PL in 8 patients and from PL during stimulation of AL in 6 patients. None of 12 patients with a postresection N1 amplitude decrease of 0%-15% from baseline presented postoperative language impairment. Decreases of 28% and 24%, respectively, of the N1 amplitude were observed in 2 patients who developed transient postoperative speech disturbances.
The application of CCEP monitoring is possible and safe in epilepsy surgery under general anesthesia. Putative AL and PL can be identified using noninvasive presurgical neuroimaging. Decrease of N1 amplitude >15% from baseline may predict postoperative language deficits.
摘要：
评价皮质皮质诱发电位(CCEP)在全身麻醉癫痫手术术中语言网络监测中的适用性。探讨在这些条件下记录的CCEP术中语言功能变化的临床相关性。
对14例癫痫患者进行了CCEP监测（6例女性，4名儿童）在全身麻醉下在左腹膜区域切除。电极条放置在前语言区（AL）和后语言区（PL），通过结构和功能磁共振成像鉴定。单脉冲电刺激以双极方式传递到相邻触点对。在切除期间,我们通过从PL记录CCEP刺激AL来监测背侧语言通路的完整性，反之亦然，取决于CCEP的稳定性和重现性。我们之前评估了CCEP的第一个阴性(N1)成分，during,切除后。
所有程序均成功完成，无不良事件。8例患者在刺激PL期间从AL获得最佳反应，6例患者在刺激AL期间从PL获得最佳反应。切除后N1振幅从基线下降0％-15％的12例患者均未出现术后语言障碍。减少28%和24%，分别,在2例发生术后短暂性言语障碍的患者中观察到N1振幅。
在全身麻醉下的癫痫手术中，CCEP监测的应用是可能且安全的。可以使用无创的术前神经成像来识别推定的AL和PL。N1振幅从基线下降>15%可以预测术后语言障碍。
对14例癫痫患者进行了CCEP监测（6例女性，4名儿童）在全身麻醉下在左腹膜区域切除。电极条放置在前语言区（AL）和后语言区（PL），通过结构和功能磁共振成像鉴定。单脉冲电刺激以双极方式传递到相邻触点对。在切除期间,我们通过从PL记录CCEP刺激AL来监测背侧语言通路的完整性，反之亦然，取决于CCEP的稳定性和重现性。我们之前评估了CCEP的第一个阴性(N1)成分，during,切除后。
所有程序均成功完成，无不良事件。8例患者在刺激PL期间从AL获得最佳反应，6例患者在刺激AL期间从PL获得最佳反应。切除后N1振幅从基线下降0％-15％的12例患者均未出现术后语言障碍。减少28%和24%，分别,在2例发生术后短暂性言语障碍的患者中观察到N1振幅。
在全身麻醉下的癫痫手术中，CCEP监测的应用是可能且安全的。可以使用无创的术前神经成像来识别推定的AL和PL。N1振幅从基线下降>15%可以预测术后语言障碍。
