唤醒麻醉下个体化语言评估对脑肿瘤切除术后患者语言功能的保护作用

关键词：唤醒麻醉  语言定位  皮质电刺激  语言评估  西方失语症成套测验

Keywords:awake anesthesia  language mapping  cortical electrical stimulation  language assessment  western aphasia battery

摘要：

      摘要 目的：探讨唤醒麻醉状态下，个体化语言功能评估在脑功能区肿瘤切除手术中，对患者语言功能的保护作用及意义。 方法：本研究纳入14例语言功能区脑肿瘤患者，在唤醒麻醉状态下利用皮质电刺激技术，通过执行个体化语言评估任务来进行语言区精准定位，在保护语言功能区的前提下切除病灶。术中语言任务主要包括命名、复述、阅读、书写、听理解和计数等方面。在术前、术后，采用西方失语症成套测验（western aphasia battery ，WAB）评估患者的语言功能。 结果：14例患者术中唤醒程度良好，能够配合功能区定位及完成术中语言评估任务。患者术后WAB评估中患者自发言语、听理解、复述、命名、阅读、书写能力较术前无明显改变（P>0.05）；失语商（aphasia quotient，AQ）术前为（94.31±8.11）分、术后为（92.54±8.04）分，差异无显著性意义（P=0.180）；大脑皮质商（cortical quotient，CQ）术前和术后分别为（94.71±6.93）分和（92.60±6.59）分，差异无显著性意义（P=0.071）。有1例患者术后出现短暂性失语，3周后复查恢复至术前水平。 结论：脑语言功能区肿瘤切除术中，在唤醒麻醉下配合直接皮质电刺激，同时进行个体化语言评估有助于对语言功能区进行精准定位，从而促进最大程度切除肿瘤的同时保护患者的语言功能，降低术后语言障碍的风险。

Abstract:

      Abstract Objective： To explore the application and protection of individualized language assessment and awake anesthesia in the surgery for patients with tumor in eloquent areas. Method： Fourteen patients with eloquent brain tumors were included. The patients were operated under awake anesthesia and given intraoperative direct electrical stimulation combined with individualized language assessment for functional mapping of the eloquent areas. Intraoperative language testing included naming， repetition， reading， writing， comprehension and counting. The language function was evaluated using the western aphasia battery (WAB) scale before and after operation. Result： Totally 14 cases were achieved awake and alert during language mapping. There were no significant changes in the performances of oral expression， auditory comprehension， repetition， naming， reading， and writing after operation(P>0.05). WAB aphasia quotient（AQ） scores were 94.31±8.11 and 92.54±8.04， respectively，with no statistically significant difference (P=0.180). WAB cortical quotient（CQ） score was 92.60±6.59， similar to that before operation (P=0.071). One case had transient aphasia after operation， and recovered to normal after 3 weeks. Conclusion： Individualized language assessment combined with awake anesthesia and intraoperative direct cortical electrical stimulation in the surgical treatment of eloquent brain tumor could protect the language function and reduce the risk of postoperative language deficits when maximizing the removal of tumors.