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題名 | Functional Brain Mapping-Assisted Resection of Gliomas in the Dominant Hemisphere=以腦部功能定位輔助優勢大腦半球神經膠質瘤的切除 |
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作者 | 曾勝弘; 吳秀蓉; 曾漢民; 林瑞明; 洪純隆; Tseng, Sheng-hong; Wu, Hsiu-jung; Tseng, Ham-min; Lin, Swei-ming; Honwg, Shen-long; |
期刊 | 中華民國外科醫學會雜誌 |
出版日期 | 20000700、20000800 |
卷期 | 33:4 民89.07-08 |
頁次 | 頁157-165 |
分類號 | 416.291 |
語文 | eng |
關鍵詞 | 腦部功能區; 神經膠質瘤; Eloquent area; Functional brain mapping; Glioma; Surgery; |
中文摘要 | 腦部重要功能區的定位對於神經膠質瘤的手術切除是非常重要的,手術中如果不確切知道重要功能區的位置,則無法將腫瘤作最大範圍的切除,甚至可能破壞重要功能區,引起併發症。在本研究中,我們對於七位罹患優勢大腦半球神經膠質瘤的病人,經由硬腦膜下電極作大腦皮質電刺激,以定位其知覺運動及語言中樞。所有病人先接受開顱手術置放硬腦膜下電極,然後在床邊進行腦部功能定位,在每一位病人都找到知覺運動及語言中樞;緊接著,這些病人接受第二次手術,其中四位接受腫瘤全切除手術,三位接受亞全切除手術。除了腫瘤切除外,二位合併有難治之癲癇的病人又在腦皮質電圖監視下接受癲癇病灶的切除。手術後,一位病人發生短暫的偏癱,但症狀在12小時後恢復;這位病人也發生說話的發動變慢的現象,此現象在一年後消失。另一位病人其手術前原有的右側偏癱在手術後沒有改變,但其知覺及語言功能良好;其他五位病人手術後完全沒有知覺運動及語言功能的缺陷。經過一至四年三個月(平均二年八個月)的追蹤,六位病人神經功能良好,另一位患有右側偏癱的病人在手術後20個月後腫瘤復發,這位病人再度接受腫瘤切除,但在二個月後死亡,二位合併有難治之癲癇的病人也完全沒有癲癇發作現象。從上述的研究,我們發現以大腦皮質電刺激作腦部功能定位可以準確的找出重要功能區的位置,而且能增加神經膠質瘤的切除範間,並減少併發症的發生。 |
英文摘要 | Localization of the eloquent areas of the brain is very important to maximize the resection of the glioma and minimize the morbidity. Electrical cortical stimulation using subdural electrodes to identify the sensorimotor cortex and language areas was performed in seven patients with glioma at the dominant hemisphere. All the patients received craniotomy to implant subdural electrodes during the first operation. Functional brain mapping was done after the operation, and the sensorimotor cortex and language areas were identified in every patient. After functional brain mapping, these patients received second operation to excise the tumors with a total of four total and three subtotal excisions. In addition to the tumor excision, two patients with intractable seizure received excision of the epileptic foci under electrocorticographic monitoring. After operation, one patient had transient hemiparesis, then recovered completely 12 hours after occurrence. This patient also had slow initiation of speech postoperatively, which disappeared one year after operation. In another patient, the preoperative right hemiparesis had no changes, and her sensory and speech functions were intact after operation. The other five patients had no sensorimotor or speech deficits after operation. After 1 to 4 years and 3 months (mean, 2 years and 8 months) of follow-up, all the patients had good neurological functions except that the patient with right hemiparesis had tumor recurrence 20 months after excision. This patient received tumor resection again and died 2 months after the second resection. The two patients with intractable seizures were free of seizure. From this study, we found functional brain mapping using electrical cortical stimulation accurately localized the sensory areas of the cortex, and the mapping was helpful for maximizing the resection of glioma and minimizing the morbidity. |
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