Yang Mingming,Xie Fan,Yuan Chongyang,et al.Application of awake anesthesia in brain functional area lesion resection for Epileptic Children[J].Journal of Clinical Pediatric Surgery,,20():946-950.[doi:10.12260/lcxewkzz.2021.10.010]
Application of awake anesthesia in brain functional area lesion resection for Epileptic Children
- Keywords:
- Epilepsy; Surgical Procedures; Operative; Brain Function Area; Awake anesthesia; Child
- CLC:
- R742.1;R614.2
- Abstract:
- Objective To evaluate the safety and feasibility of awake anesthesia during brain functional area lesion resection for epileptic children.Methods Clinical data, mode of awake anesthesia, surgical position, intraoperative complications and postoperative follow-ups were recorded for 18 epileptic children undergoing brain functional area lesion resection under awake anesthesia.Results For 17 cases, asleep-awake-asleep (3A) model was adopted and awake lesion resection successful.One case of recurrent seizure during neurological function test after waking was operated under general anesthesia.Body position was spinal (n=5) and lateral decubitus (n=13).Intraoperative complications:included nausea (n=3), seizure (n=6) and premonition (n=3).All symptoms improved after treatments.During a follow-up period of 2-7 years, there has no neurological dysfunction.Engel grade was Ⅰ (n=12), Ⅱ (n=4) and Ⅲ (n=2).Conclusion Awake anesthesia in brain functional area lesion resection is both safe and feasible for epileptic children.The keys are sufficient preoperative preparations and meticulous anesthesia managements.
References:
1 李京生,田肇隆,王天龙.55例患儿颅内癫痫病灶切除术麻醉的回顾性分析[J].神经疾病与精神卫生,2011,11(4):382-384.DOI:10.3969/j.issn.1009-6574.2011.04.019. Li JS,Tian ZL,Wang TL.Retrospective analysis of anesthesia management for 55 children undergoing excision of epileptogenic foci[J].Journal of Neuroscience and Mental Health,2011,11(4):382-384.DOI:10.3969/j.issn.1009-6574.2011.04.019.
2 Maesawa S,Nakatsubo D,Fujii M,et al.Application of awake surgery for epilepsy in clinical practice[J].Neurol Med Chir (Tokyo),2018,58(10):442-452.DOI:10.2176/nmc.oa.2018-0122.
3 Chung YH,Kim WH.Anesthetic management of awake craniotomy with laryngeal mask airway and dexmedetomidine in risk patients[J].Korean J Anesthesiol,2012,63(6):573-575.DOI:10.4097/kjae.2012.63.6.573.
4 Chacko AG,Thomas SG,Babu KS,et al.Awake craniotomy and electrophysiological maping for eloquent area tumours[J].Clin Neurol Neurosurg,2013,115(3):329-334.DOI:10.1016/j.clineuro.2012.10.022.
5 郭强,张伟,朱丹.儿童致痫性低级别肿瘤的手术策略与切除范围设计[J].临床小儿外科杂志,2019,18(9):719-722.DOI:10.3969/j.issn.1671-6353.2019.09.002. GuoQ,ZhangW,Zhu D.Surgical strategies and scope designs of resecting epileptic low-grade tumors in children[J].Journal of Clinical Pediatric Surgery,2019,18(9):719-722.DOI:10.3969/j.issn.1671-6353.2019.09.002.
6 Rosenstock T,Picht T,Schneider H,et al.Left perisylvian tumor surgery aided by TMS language mapping in a 6-year-old boy:case report[J].Childs Nerv Syst,2019,35(1):175-181.DOI:10.1007/s00381-018-3944-1.
7 Elise R,Pierre M,Philippe D,et al.A case of awake craniotomy surgery in an 8-year-old girl[J].Childs Nerv Syst,2017,33:1039-1042.DOI:10.1007/s00381-017-3463-5.
8 白德明,刘颖,孟喜军,等.小儿骨科围术期的心理干预[J].临床小儿外科杂志,2014,13(6),521-524.DOI:10.3969/j.issn.1671-6353.2014.06.015. Bai DM,Liu Y,Meng XJ,et al.Application of psychological intervention during orthopedic perioperative period[J].Journal of Clinical Pediatric Surgery,2014,13(6):521-524.DOI:10.3969/j.issn.1671-6353.2014.06.015.
9 孙梅,陈韵,王国良,等.小儿难治性癫痫病灶唤醒手术切除的麻醉管理[J].中国微侵袭神经外科杂志,2019,24(10):440-443.DOI:10.11850/j.issn.1009-122X.2019.10.003. Sun M,ChenY,Wang GL,et al.Anesthesia management of awake craniotomy for the resection of refractory seizure foci in children[J].Chin J Minim Invasive Neurosurg,2019,24(10):440-443.DOI:10.11850/j.issn.1009-122X.2019.10.003.
10 Fernandes ML,Oliveira WM,Santos Mdo C,et al.Sedation for electroencephalography with dexmedetomidine or chloral hydrate:a comparative study on the qualitative and quantitative electroencephalogram pattern[J].Neurosurg Anesthesiol,2015,27(1):21-25.DOI:10.1097/ANA.0000000000000077.
11 Mason KP,O’Mahony E,Zurakowski D,et al.Effect of dexmetomidine sedation on the EEG in children[J].Paediatr Anaesth,2009,19(12):1175-1183.DOI:10.1111/j.1460-9592.2009.03160.x.
12 Sheshadri V,Chandramouli BA.Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report[J].J Clin Anesth,2016,32:199-202.DOI:10.1016/j.jclinane.2016.03.009.
13 Englot DJ.A modern epilepsy surgery treatment algorithm:incorporating traditional and emerging technologies[J].Epilepsy Behav,2018,80:68-74.DOI:10.1016/j.yebeh.2017.12.041.
Memo
收稿日期:2020-02-20。
基金项目:广东省医学科学技术研究基金项目（编号：B2018169）
通讯作者:魏涧琦,Email:weijianqi@aliyun.com