Do we Need to Wake Patients up during Cortical Surgery?

L. Zelaya, R. Sola, P. Pulido, J. Pastor
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引用次数: 4

Abstract

In recent years, a renewed fashion for awake surgery has appeared. In spite of its undoubted utility for scientific research, this technique has several limitations and flaws, usually not debated by parts of the scientific community. We will discuss the aims and limitations of cortical surgery, especially the points relevant to protecting the patient. These objectives should define the guidelines that direct clinical practice. We will review the awake technique as well as various tools used in intraoperative neurophysiological monitoring (IONM) to explore and monitor several cortical functions during long surgeries. The main topics discussed include electrocorticography (ECoG) and cortically recorded evoked potentials (EP), including somatosensory, visual and auditory. Later, we will discuss methods to identify and survey motor functions as motor-evoked potentials, although they are elicited trans-cranially. Finally, we will briefly discuss a promising technique to monitor some language functions in anaesthetized patients, such as cortico-cortical evoked potentials (CCEP). We will address in depth some technical questions about electrical stimulation whose full relevance are not always considered. Finally, we will discuss why, in the absence of empirical facts showing unequivocal superiority in post-surgical outcome, we have to awaken patients, especially when an alternate possibility exists without worst clinical results, as is the case for IONM.
在皮质手术中我们需要叫醒病人吗?
近年来,出现了清醒手术的新潮流。尽管这种技术在科学研究中具有无可置疑的效用,但它也有一些局限性和缺陷,科学界的一些人通常不会对此进行辩论。我们将讨论皮质手术的目的和局限性,特别是与保护患者有关的要点。这些目标应该定义指导临床实践的指导方针。我们将回顾清醒技术以及术中神经生理监测(IONM)中使用的各种工具,以探索和监测长时间手术期间的几种皮质功能。主要讨论的主题包括脑皮质电图(ECoG)和脑皮质诱发电位(EP),包括体感、视觉和听觉。稍后,我们将讨论识别和调查作为运动诱发电位的运动功能的方法,尽管它们是经颅激发的。最后,我们将简要讨论一种很有前途的技术来监测麻醉患者的一些语言功能,如皮质-皮质诱发电位(CCEP)。我们将深入讨论一些关于电刺激的技术问题,这些问题的完全相关性并不总是被考虑到。最后,我们将讨论为什么在缺乏经验事实显示术后结果的明确优势的情况下,我们必须唤醒患者,特别是当存在另一种可能性而没有最差的临床结果时,如IONM的情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
0.20
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