Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperati...Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Methods Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Results Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Conclusions Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.展开更多
目的将英文版唤醒状态下感觉运动功能评定量表(sensory-motor profile awake,SMP-a)汉化成中文版(the Chinese Version of SMP-a),并分析该量表在唤醒麻醉下开颅手术患者中应用的信效度。方法81例肿瘤位置均靠近或已位于感觉运动功能区...目的将英文版唤醒状态下感觉运动功能评定量表(sensory-motor profile awake,SMP-a)汉化成中文版(the Chinese Version of SMP-a),并分析该量表在唤醒麻醉下开颅手术患者中应用的信效度。方法81例肿瘤位置均靠近或已位于感觉运动功能区的患者,在行唤醒麻醉开颅手术前后均使用中文版SMP-a对每位患者的全身感觉运动功能做精确评估,最后运用SPSS统计软件分析其信效度。结果汉化中文版SMP-a全量表Cronbach's α系数为0.971,面部、手部、腿部、感觉四个分量表Cronbach's α系数分别为0.965、0.989、0.981以及0.970;总分、面部、手部、腿部及感觉的重测信度分别为0.910、0.904、0.884、0.898及0.695,评分者一致性信度分别为0.949、0.960、0.934、0.887及0.660以上;感觉运动功能总分与生活调查问卷(SF-36)生理机能因子以及KPS评分Pearson相关系数分别为0.868、0.790。结论中文版SMP-a量表在术前、术后的感觉运动评估中具有较好的重测信度与内部一致性效度以及效标效度。该量表在唤醒麻醉开颅手术中具有可行性,可根据患者可能损害的感觉运动部位反复施测确定其损害程度。展开更多
Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions ...Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.展开更多
文摘Background Successful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery. Methods Thirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated. Results Intraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases. Conclusions Intraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.
文摘目的将英文版唤醒状态下感觉运动功能评定量表(sensory-motor profile awake,SMP-a)汉化成中文版(the Chinese Version of SMP-a),并分析该量表在唤醒麻醉下开颅手术患者中应用的信效度。方法81例肿瘤位置均靠近或已位于感觉运动功能区的患者,在行唤醒麻醉开颅手术前后均使用中文版SMP-a对每位患者的全身感觉运动功能做精确评估,最后运用SPSS统计软件分析其信效度。结果汉化中文版SMP-a全量表Cronbach's α系数为0.971,面部、手部、腿部、感觉四个分量表Cronbach's α系数分别为0.965、0.989、0.981以及0.970;总分、面部、手部、腿部及感觉的重测信度分别为0.910、0.904、0.884、0.898及0.695,评分者一致性信度分别为0.949、0.960、0.934、0.887及0.660以上;感觉运动功能总分与生活调查问卷(SF-36)生理机能因子以及KPS评分Pearson相关系数分别为0.868、0.790。结论中文版SMP-a量表在术前、术后的感觉运动评估中具有较好的重测信度与内部一致性效度以及效标效度。该量表在唤醒麻醉开颅手术中具有可行性,可根据患者可能损害的感觉运动部位反复施测确定其损害程度。
文摘Background: The importance of monitoring cognition during awake craniotomy has been well described in previous studies. The relevance of being coached during such a procedure has received less attention and questions still remain unanswered about what factors are the most important herein. Objective: The aim of this study was to qualitatively analyze what factors were, according to our patients, important in being coaching during awake craniotomy. Methods: Twenty-six patients who underwent awake craniotomy received a questionnaire about their experiences during the procedure. The questions concerned different aspects of the pre-operative part, the operation itself and coaching aspects. Answers were qualitatively analyzed by two investigators and per question, different answer categories were made. Results: Two thirds of the 20 patients who responded to the questionnaire reported anxiety in the days before or during the operation, varying from general anxiety for being awake during surgery to anxiety for very specific aspects such as opening the skull. The constant presence of the neuropsychologist and a transparent communication during the procedure were most frequently (65% of all the answers) reported as helpful in staying calm. Conclusion: Results of this descriptive study show that patients experience different anxieties before and during an awake craniotomy and give more insight into what factors are important for patients in being coached during such an operation. This study gives directions for clinicians in improving their role as a coach.
