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Intraoperative awake anesthesia applied for tumor excision in cerebral functional areas

Journal of Medical Colleges of PLA(China) 2007年第4期22卷 238-241页

作者：屠伟峰胡渤刘中华吴群林郄文斌戴建强徐波施冲 Department of Anesthesiology Liuhua Bridge HospitalGuangzhou 510010China

Objective:To observe the feasibility and safety of awake anesthesia for tumor excisions in pa- tients with brain tumors involving cerebral functional ***:Fifty patients with brain tumors in- volving cerebral functional areas,ASAⅠ-Ⅱgrade,were enrolled in this *** and remifentanil were used for total intravenous anesthesia,and a laryngeal mask airway(LMA)was inserted for the air- way opening and synchronized intermittent mandatory ventilation(SIMV).At the surgeon's request for an intraoperative wake-up test,the propofol infusion was stopped advance of 10-15 min,the remifentanil in- fusion rate was decreased to 0.050-0.075μg/kg from 0.10-0.20μg/kg per min for easing surgical pain. The LMA was removed until the patient *** anesthesiologist then kept up an on-going neuro- logical *** that,anesthesia was re-deepened and LMA was re-inserted until the whole surgery was ***:Forty-six of 50 patients(92%)were successfully awakened and 4 (8%)failed to complete the intraoperative wake-up test because of dyspnea,over-sedation,or severe hy *** severe complications occurred during the whole ***:During the awake anesthetic period,the intraoperative wake-up test combined with navigation,evoked potential and ultra- sound techniques can help surgeons excise maximumly and precisely the brain tumors near to or in the functional areas.

关键词： awake anesthesia tumor excision cerebral functional areas target-controlled infusion laryngeal mask airway

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Preoperative 3T high field blood oxygen level dependent functional magnetic resonance imaging for glioma involving sensory cortical areas

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Chinese Medical Journal 2010年第8期123卷 1006-1010页

作者： LI Shao-wu WANG Jiang-fei JIANG Tao LI Shou-wei ZHANG Wen-bo LI Zi-xiao ZHANG Zhong DAI Jian-ping WANG Zhong-cheng Neuroimaging Center Beijing Neurosurgical Institute Capital Medical University Beijing 100050 China Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100050 China Department of Neurosurgery No. 1 Hospital of Harbin Medical University Harbin Heilongjiang 150001 China Minnesota Epilepsy Group Saint Paul Minnesota 55102 USA

Background Localization of sensory cortical areas during the operation is essential to preserve the sensory function. Intraoperative direct electrostimulation under awake anesthesia is the golden standard but time-consuming. We applied 3T high field blood oxygen level-dependent （BOLD） functional magnetic resonance imaging （fMRI） to identify the relationship between glioma and cortical sensory areas preoperatively and to guide intraoperative direct electrostimulation for quick and precise localization. Methods Five glioma patients with sensory cortex involvement by or next to the lesion had preoperative BOLD fMRI to determine the spatial relationship of cortical sensory areas to the tumours. Bilateral hand opposite movement was performed by these patients for fMRI. Precentral and postcentral gyri were identified by electrical stimulation during the operation. Karnofsky Performance Status scores of the patients＇ pre- and postoperative and the role of BOLD fMRI were evaluated. Results The cortical sensory areas were all activated in five glioma patients involving postcentral gyrus areas by BOLD fMRI with bilateral hand opposite movement. The detected activation areas corresponded with the results from cortical electrical stimulation. Conclusions The relationship between cortical sensory areas and tumour can be accurately shown by BOLD fMRI before operation. And the information used to make the tumour resection could obtain good clinical results.

关键词： functional magnetic resonance imaging somatosensory area awake anesthesia cortical stimulation

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