UNASSIGNED:清醒开颅手术与多模态神经生理标测和轴内肿瘤切除监测的结合没有得到很好的描述,但可能有我们试图调查的理论上的好处。
UNASSIGNED:所有接受清醒开颅手术切除肿瘤的患者,皮质和/或皮质下刺激以及一个或多个皮质脑电图(ECoG/EEG),从两个中心的两名外科医生在5年内的手术记录中确定了运动或体感诱发电位。病人,对手术和结局数据进行了整理.进行统计分析以评估预测术中癫痫发作和手术结果的因素。
未经批准:83例患者的中位年龄为50岁(18-80岁)。80%的胶质瘤(37%的低级别)和13%的转移。35%(语言区域)和24%(运动区域)的皮质作图为阴性。80%的患者实现了完全或几乎完全切除,5%的严重长期神经功能缺损。负皮质作图与正皮质下作图相结合的比例为42%,与接受正皮质作图的患者相比,切除率的程度无显着差异(p=0.95)。在14%内无法完成唤醒映射,但对切除程度(p=0.55)或并发症发生率(p=0.09)没有影响。术中癫痫发作发生率为11%,与术中EEG尖峰显着相关(p=0.003)。
UNASSIGNED:Awake多模态监测是一种安全且耐受性良好的技术。在清醒开颅手术中止的情况下,它可以保留切除程度和临床结果。负皮质映射结合正皮质下映射也被证明是安全的,虽然迄今没有很好的描述。皮质脑电图进一步能够区分癫痫发作活动和真正的阳性映射,以及在完全临床癫痫发作之前成功治疗尖峰。
UNASSIGNED: The combination of awake craniotomy with multimodal neurophysiological mapping and monitoring in intra-axial tumour resection is not well described, but may have theoretical benefits which we sought to investigate.
UNASSIGNED: All patients undergoing awake craniotomy for tumour resection with cortical and/or subcortical stimulation together with one or more of electrocorticography (ECoG/EEG), motor or somatosensory evoked potentials were identified from the operative records of two surgeons at two centres over a 5 year period. Patient, operative and outcome data were collated. Statistical analysis was performed to evaluate factors predictive of intra-operative seizures and surgical outcomes.
UNASSIGNED: 83 patients with a median age 50 years (18-80 years) were included. 80% had gliomas (37% low grade) and 13% metastases. Cortical mapping was negative in 35% (language areas) and 24% (motor areas). Complete or near total resection was achieved in 80% with 5% severe long-term neurological deficits. Negative cortical mapping was combined with positive subcortical mapping in 42% with no significant difference in extent of resection rates to patients undergoing positive cortical mapping (p = 0.95). Awake mapping could not be completed in 14%, but with no compromise to extent of resection (p = 0.55) or complication rates (p = 0.09). Intraoperative seizures occurred in 11% and were significantly associated with intra-operative EEG spikes (p = 0.003).
UNASSIGNED: Awake multi-modal monitoring is a safe and well tolerated technique. It provides preservation of extent of resection and clinical outcomes in cases of aborted awake craniotomy. Negative cortical mapping in combination with positive subcortical mapping was also shown to be safe, although not hitherto well described. Electrocorticography further enables the differentiation of seizure activity from true positive mapping, and the successful treatment of spikes prior to full clinical seizures occurring.