[1]许　耿　路俊锋　杨　忠　施建斌　吴秋月　王　烨　庄冬晓　吴劲松.神经电生理监测技术在功能区胶质瘤术中的应用[J].中国临床神经外科杂志,2016,(06):323-326.[doi:10.13798/j.issn.1009-153X.2016.06.002]
　XU Geng,LU Jun-feng,YANG Zhong,et al.Application of intraoperative neuroelectrophysiologic monitoring to gliomas resection in eloquent function brain regions[J].,2016,(06):323-326.[doi:10.13798/j.issn.1009-153X.2016.06.002]
点击复制

神经电生理监测技术在功能区胶质瘤术中的应用()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年06期
页码:
323-326
栏目:
论著
出版日期:
2016-06-25

文章信息/Info

Title:
Application of intraoperative neuroelectrophysiologic monitoring to gliomas resection in eloquent function brain regions
文章编号:
1009-153X（2016）06-0323-04
作者:
许　耿　路俊锋　杨　忠　施建斌　吴秋月　王　烨　庄冬晓　吴劲松
200040 上海，复旦大学附属华山医院神经外科
Author(s):
XU Geng;  LU Jun-feng;  YANG Zhong;  SHI Jian-bin;  WU Qiu-yue;  WANG Ye;  ZHUANG Dong-xiao;  WU Jing-song
Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai 200040, China
关键词:
胶质瘤; 脑功能区; 显微手术; 术中神经电生理监测; 疗效
Keywords:
Gliomas;  Eloquent-function brain region;  Intraoperative neuroelectrophysiologic monitoring;  Microsurgery
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2016.06.002
文献标志码:
A
摘要:
目的 探讨神经电生理监测在功能区胶质瘤术中的应用价值。方法 对2012年1月至2014年12月术中行神经电生理监测的738例功能区胶质瘤的临床资料进行回顾性分析。结果 608例在全麻下行术中神经电生理监测，130例在唤醒麻醉下行运动和或语言功能定位。所有病例术后近期运动障碍发生率为11.7%，远期为3.8%；语言区胶质瘤术后近期的失语率为28.8%，远期为4.1%。术中MRI辅助下进行电生理监测347例，全切率为89.3%。全麻下3.6%的患者术中出现癫痫大发作；唤醒麻醉下2.3%的患者出现一侧肢体或嘴角抽搐，仅1例（0.8%）出现癫痫大发作。结论 根据胶质瘤所在的部位选择适当的术中神经电生理监测技术，有助于最大程度切除肿瘤的同时，保护患者的功能皮层和皮层下重要功能通路，降低致残率，提高远期生活质量。
Abstract:
Objective To explore the value of intraoperative neuroelectrophysiologic monitoring (IONM) to the surgery for gliomas in eloquent function brain regions. Method The clinical data of 738 patients with gliomas in eloquent function brain regions, who underwent surgery under IONM from January, 2012 to December, 2014, were analyzed retrospectively. Results Of 738 patients, 608 underwent somatosensory evoked potential or motor evoked potential monitoring under general anesthesia and 130 did cortical and subcortical motor mapping or awake language mapping. Eighty-six patients (11.7%) suffered from early motor deficit after the surgery. Late motor deficit was observed in 28 patients (3.8%). Twenty-one patients (28.8%, 21/73) had early speech deficit and late speech deficit was only observed in 3 patients (4.1%, 3/73). The rate of gross total resection of the tumors was 89.3% in 738 patients. Conclusions IONM can be applied safely and effectively to the resection of gliomas in the eloquent function brain regions because it is helpful to the protection of the eloquent function cortexes and subcortical pathways and total resection of the tumors as possible in the patients with gliomas in eloquent function brain regions.

参考文献/References:

[1] 《中国中枢神经系统胶质瘤诊断和治疗指南》编写组. 中 国中枢神经系统胶质瘤诊断和治疗指南（2012精简版） [J]. 中华医学杂志，2012，92（33）：2309-2313.
[2] 周琪琪，张小锋. 神经监测技术在临床手术中的应用[M]. 北京：中国社会出版社，2005.
[3] 窦万臣. 术中神经电生理监测[M]. 北京：人民卫生出版 社，2009.
[4] 陈正和，陈忠平. 术中神经电生理监护对保护神经功能的 应用[J]. 中国神经肿瘤杂志，2013，11（3）：194-198.
[5] 路俊锋，吴劲松，朱国行. 神经电生理学检查和术中应用 [M]. 见：周良辅. 现代神经外科学. 第二版. 上海：复旦大 学出版社，2015. 158-198.
[6] 中国脑胶质瘤协作组. 唤醒状态下切除脑功能区胶质瘤 手术技术的专家共识[J]. 中国微侵袭神经外科杂志， 2013，18（3）：143-149.
[7] 路俊锋，章　捷，吴劲松，等. 3.0 T 术中磁共振成像引导 下唤醒麻醉联合术中语言皮质定位技术在语言区脑胶 质瘤手术中的应用[J]. 中华外科杂志，2011，49（8）：693- 698.
[8] Lu J, Wu J, Yao C, Zhuang D, et al. Awake language map- ping and 3-Tesla intraoperative MRI-guided volumetric resection for gliomas in language areas [J]. J Clin Neurosci, 2013, 20(9)：1280-1287.
[9] De Witt Hamer PC, Robles SG, Zwinderman AH, et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome：a meta-analysis [J]. J Clin Oncol, 2012, 30(20): 2559-2565.
[10] Duffau H, Lopes M, Arthuis F, et al. Contribution of intrao- perative electrical stimulations in surgery of low grade glio- mas: a comparative study between two series without (1985- 96) and with (1996-2003) functional mapping in the same institution [J]. J Neurol Neurosurg Psychiatry, 2005, 76(6): 845-851.
[11] Carrabba G, Fava E, Giussani C, et al. Cortical and sub- cortical motor mapping in rolandic and perirolandic glioma surgery: impact on postoperative morbidity and extent of resection [J]. J Neurosurg Sci, 2007, 51(2): 45-51.
[12] Keles GE, Lundin DA, Lamborn KR, et al. Intraoperative subcortical stimulation mapping for hemispherical periro- landic gliomas located within or adjacent to the descending motor pathways：evaluation of morbidity and assessment of functional outcome in 294 patients [J]. J Neurosurg, 2004, 100(3): 369-375.
[13] Krieg SM, Shiban E, Droese D, et al. Predictive value and safety of intraoperative neurophysiological monitoring with motor evoked potentials in glioma surgery [J]. Neurosurgery, 2012, 70(5): 1060-1061.
[14] Krieg SM, Schaffner M, Shiban E, et al. Reliability of intra- operative neurophysiological monitoring using motor evoked potentials during resection of metastases in motor-eloquent brain regions：clinical article [J]. J Neurosurg, 2013, 118(6): 1269-1278.
[15] Neuloh G, Pechstein U, Schramm J. Motor tract monitoring during insular glioma surgery [J]. J Neurosurg, 2007, 106 (4): 582-592.
[16] Zhu FP, Wu JS, Song YY, et al. Clinical application of motor pathway mapping using diffusion tensor imaging tractography and intraoperative direct subcortical stimula- tion in cerebral glioma surgery: a prospective cohort study [J]. Neurosurgery, 2012, 71(6): 1170-1184.
[17] Sanai N, Mirzadeh Z, Berger MS. Functional outcome after language mapping for glioma resection [J]. N Engl J Med, 2008, 358(1): 18-27.
[18] Duffau H, Capelle L, Sichez N, et al. Intraoperative mapping of the subcortical language pathways using direct stimula- tions. An anatomo-functional study [J]. Brain, 2002, 125(Pt 1): 199-214.
[19] Bello L, Gambini A, Castellano A, et al. Motor and language DTI Fiber Tracking combined with intraoperative subcorti- cal mapping for surgical removal of gliomas [J]. Neuroimage, 2008, 39(1): 369-382.

相似文献/References:

[1]常英男　王　策　赵天书.SOX2基因在胶质瘤中的表达及生物学作用[J].中国临床神经外科杂志,2016,(05):270.[doi:10.13798/j.issn.1009-153X.2016.05.005]
　CHANG Ying-nan,WANG Ce,ZHAO Tian-shu..Expression of SOX2 gene and its biological role in human gliomas[J].,2016,(06):270.[doi:10.13798/j.issn.1009-153X.2016.05.005]
[2]赛　克　陈忠平.胶质瘤的疗效评价[J].中国临床神经外科杂志,2016,(06):321.[doi:10.13798/j.issn.1009-153X.2016.06.001]
[3]李剑峰　陈银生　赛　克　张湘衡　柯　超　杨群英　牟永告　许海雄　陈忠平.173例胶质瘤预后的影响因素分析[J].中国临床神经外科杂志,2016,(06):327.[doi:10.13798/j.issn.1009-153X.2016.06.003]
　LI Jian-feng,CHEN Yin-sheng,SAI Ke,et al.Prognostic factors for gliomas: analysis of 173 cases[J].,2016,(06):327.[doi:10.13798/j.issn.1009-153X.2016.06.003]
[4]云德波　杨宇焦　张　逵　范润金　张　渊　杜贻庆.瘤周谷氨酸、天门冬氨酸水平与胶质瘤继发性 癫痫的相关性[J].中国临床神经外科杂志,2016,(06):331.[doi:10.13798/j.issn.1009-153X.2016.06.004]
　YUN De-bo,YANG Yu-Jiao,ZHANG Kui,et al.Relationship of levels of glutamate and aspartate in peritumorous tissues with seizures in patients with gliomas[J].,2016,(06):331.[doi:10.13798/j.issn.1009-153X.2016.06.004]
[5]黄书岚　成于思　王　辉　汪超甲.FAK siRNA重组质粒的构建及其对胶质瘤U251细胞 增殖及侵袭能力的抑制作用[J].中国临床神经外科杂志,2016,(06):336.[doi:10.13798/j.issn.1009-153X.2016.06.006]
　HUANG Shu-lan,CHENG Yu-si,WANG Hui,et al.Construction of siRNA recombinant plasmid targeting focal adhesion kinase gene and its effect on the proliferation and invasiveness of human glioma U251cells[J].,2016,(06):336.[doi:10.13798/j.issn.1009-153X.2016.06.006]
[6]林　雨　张　恺　李　帅　杨学军.磁共振数字化手术单元在指导胶质瘤治疗中的作用[J].中国临床神经外科杂志,2016,(06):345.[doi:10.13798/j.issn.1009-153X.2016.06.009]
[7]戴黎明　徐成仕　王泽芬　曹长军　李志强.VEGF单抗对低氧环境下C6胶质瘤细胞侵袭性的影响[J].中国临床神经外科杂志,2016,(04):219.[doi:10.13798/j.issn.1009-153X.2016.04.009]
　DAI Li-ming,XU Cheng-shi,WANG Ze-fen,et al.Effect of nonoclonal antibody of VEGF on C6 glioma cells invasiveness under hypoxia and the role of FAK/Pyk2[J].,2016,(06):219.[doi:10.13798/j.issn.1009-153X.2016.04.009]
[8]彭泽生　田道锋　张申起　陈谦学.miR-370-3p对胶质母细胞瘤U87-MG细胞株增殖能力的影响[J].中国临床神经外科杂志,2016,(04):223.[doi:10.13798/j.issn.1009-153X.2016.04.010]
　PENG Ze-sheng,TIAN Dao-feng,ZHANG Shen-qi,et al.Effects of MircoRNA-370-3p on proliferation of glioma cell line U87-MG and its potential mechanism[J].,2016,(06):223.[doi:10.13798/j.issn.1009-153X.2016.04.010]
[9]冯　驰　郭双毅　程龙海　罗　杰.氯喹通过抑制自噬促进TRAIL诱导的胶质瘤细胞凋亡[J].中国临床神经外科杂志,2016,(04):227.[doi:10.13798/j.issn.1009-153X.2016.04.011]
　FENG Chi,GUO Shuang-yi,CHENG Long-hai,et al.Chloroquine promotes TRAIL-induced apoptosis of glioma cells through inhibition of autophagy[J].,2016,(06):227.[doi:10.13798/j.issn.1009-153X.2016.04.011]
[10]杨佃旭　徐志明　李晓梅　王丽丽　王桂松.突入桥小脑角区胶质瘤的诊治分析（附5例报告）[J].中国临床神经外科杂志,2016,(03):171.[doi:10.13798/j.issn.1009-153X.2016.03.014]
[11]朱　菲　胡雪飞　叶　红.神经导航辅助显微手术切除脑功能区胶质瘤的术中配合[J].中国临床神经外科杂志,2015,(05):307.[doi:10.13798/j.issn.1009-153X.2015.05.019]
[12]何桂录　陈保东　曾小君　叶　海　杨璐军　马宇强.多模态神经导航辅助下手术切除脑运动区胶质瘤1例[J].中国临床神经外科杂志,2019,(04):446.[doi:10.13798/j.issn.1009-153X.2019.07.025]
[13]何桂录　陈保东　曾小君　叶　海　杨璐军　马宇强.多模态神经导航辅助下手术切除脑运动区胶质瘤1例[J].中国临床神经外科杂志,2019,(07):446.[doi:10.13798/j.issn.1009-153X.2019.07.025]

备注/Memo

备注/Memo:
基金项目：国家“十二五”科技支撑计划（2014BAI04B05）；国家自然科学基金（81271517；81401395）
通讯作者：吴劲松，E-mail：wjsongc@126.com
更新日期/Last Update: 2016-06-20