摘要： 目的  探讨直接电刺激在脑功能区胶质瘤手术中的应用方法和临床意义。方法  对2003 年1月-2012 年1月接受大脑功能区胶质瘤手术中行功能区直接电刺激的157例患者的临床资料进行回顾总结。结果  术中经皮质电刺激4 例呈阴性，其余153 例分别刺激出运动功能区皮质（139 例）、感觉功能区皮质（21 例）和语言相关功能区皮质（91 例）；计数中断阳性区域主要位于左侧中央前回下方、额下回盖部、额下回三角部、额中回后部和额上回后部。术后MRI 显示全切除92 例（58.60%）、次全切除55 例（35.03%）、部分切除10 例（6.37%）。术后病理证实：低级别胶质瘤共110 例（70.06%），包括星形细胞瘤71 例、少突胶质细胞瘤26 例和少突-星形细胞瘤13 例；高级别胶质瘤47 例（29.94%），分别为胶质母细胞瘤19 例、间变性星形细胞瘤15 例和间变性少突胶质细胞瘤13 例。术后53 例（33.76%）出现短暂性肢体运动障碍、39 例（24.84%）出现短暂性语言功能障碍，仅4 例（2.55%）发生永久性神经功能障碍。结论  皮质电刺激技术是一种可靠无创的脑功能区定位方法，用于脑胶质瘤外科手术可最大程度并安全切除肿瘤。

关键词: 大脑皮质； 电刺激； 神经胶质瘤； 监测, 手术中； 麻醉, 静脉； 清醒镇静

Abstract: Objective To report our experiences of direct cortical stimulation in surgery of gliomas located in eloquent areas. Methods Clinical data of 157 patients with gliomas underwent awake craniotomy with the direct electrical stimulation for functional mapping of the eloquent areas were analysed retrospectively. Results Negative cortical stimulation was found in 4 patients, and positive cortical stimulation was achieved in 153 patients (97.45% ). Four hundred and ninty -six cortical sites in 139 patients were detected for motor response by direct electrical stimulation, 70 sites in 21 patients for sensory, 112 sites in 91 patients for language (such as counting and naming). The positive areas of counting disturbance were mainly seen at the lower part of left precentral gyri operculum of left inferior frontal gyri, triangular part of left inferior frontal gyri, posterior part of left middle frontal gyri, and posterior part of left superior frontal gyri. Postoperative MRI showed 92 patients (58.60%) achieved total resection, 55 cases (35.03%) subtotal and 10 cases (6.37%) partial. One hundred and ten patients (70.06%) were diagnosed as having low grade glimas, including 71 cases of astrocytoma, 26 cases of oligodendroglioma, and 13 cases of mixed astro ? oligodendroglioma, 47 patients (29.94% ) were high grade gliomas, including 19 cases of glioblastoma, 15 cases of anaplastic astrocytoma, and 13 cases of anaplastic oligodendroglioma. After operation 53 patients (33.76% ) occurred transient postoperative paralysis, 39 patients (24.84% ) transient language disturbance and 4 patients (2.55%) permanent neurological deficits. Conclusion Intraoperative direct electrical stimulation is a reliable, precise and safety method for functional mapping of the eloquent areas. This technique allows us to achieve 'maximal safety resection' in glioma surgery．

Key words: Cerebral cortex, Electric stimulation, Glioma, Monitoring, intraoperative, Anesthesia, intravenous, Conscious sedation