| 摘要: |
| 目的 探讨依托咪酯语言及记忆评估的Wada试验（eSAM-Wada试验）的安全性及其对运动、语言和记忆功能评估的效果。方法 回顾性分析深圳大学总医院神经外科癫痫中心5例行eSAM-Wada试验的难治性癫痫患者的临床资料。在动脉数字减影血管造影（DSA）操作过程中，微导管到达靶血管后给予2 mg依托咪酯静脉推注，之后以0.004 mg·kg-1·min-1微量泵持续泵注。评估患者运动、语言及记忆功能的改变和术中的不良反应。结果 5例患者均完成整个eSAM-Wada试验流程，其中2例患者完成血管超选下的eSAM-Wada试验。有3例为左利手，2例为右利手。3例左利手患者中2例语言优势侧仍位于左侧半球，2例右利手患者的语言优势侧均位于左侧半球。4例患者为左侧半球广泛病变，其中2例记忆的优势侧位于左侧颞叶，1例记忆为双侧优势，1例记忆优势侧转移至右侧颞叶。2例患者进行了后续切除性手术，1例患者进行了立体定向脑电图电极引导下热凝毁损术，1例患者出现左下肢一过性无力，运动、语言及记忆功能改变均与eSAM-Wada试验预测结果相符。2例患者癫痫发作可能与操作流程中依托咪酯静脉推注速度过快有关，给药时间改为>30 s后，其他2例患者再无癫痫发作。结论 eSAM-Wada试验是癫痫外科全面评估运动、语言及记忆功能较为可靠且相对安全的方法，与血管超选技术结合可以更有效地指导涉及功能区的颅脑外科手术治疗。 |
| 关键词: 依托咪酯 语言与记忆评估 Wada试验 癫痫 |
| DOI：10.16781/j.0258-879x.2020.12.1398 |
| 投稿时间：2020-04-26修订日期：2020-06-05 |
| 基金项目:深圳市科技创新委员会基础研究学科布局项目（JCYJ20170412111316339），深圳大学总医院科研启动基金（SUGH2018QD067），深圳市科技创新委员会基础研究基金（JCYJ20170818100220010）. |
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| Etomidate speech and memory-Wada test in motor, speech and memory assessment in epilepsy surgery: preliminary application |
| MENG Xiang-hong,FU Meng-meng,LI Rui-qi,WU Wu-chen,TAO Wei,DU Shi-wei,QIU Ming,CHEN Fu-yong* |
(Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518065, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the safety of etomidate speech and memory-Wada test (eSAM-Wada) and the efficacy of eSAM-Wada in the function assessment of motor, speech and memory. Methods The clinical data of five patients with intractable epilepsy who underwent eSAM-Wada in the Department of Neurosurgery, Shenzhen University General Hospital were retrospectively analyzed. During the procedures of digital subtraction angiography (DSA), 2 mg etomidate was administered intravenously after the microcatheter reached the target vessel, followed by 0.004 mg·kg-1·min-1 continuous intravenous pumping. The changes of motor, speech and memory functions and intraoperative adverse effects were observed. Results All the five patients completed the whole procedure of eSAM-Wada, and two patients completed eSAM-Wada under vascluar superselection. Of the five patients, three were left-handed and two were right-handed. Among the three left-handed patients, the speech dominant hemisphere was located in the left hemisphere in two patients, while the other two right-handed patients had their speech dominance in the left hemisphere. Four patients had extensive lesions in the left hemisphere. The dominant side of memory was located in the left temporal lobe in two cases, bilateral dominance in one case, and completely transfering to the right temporal lobe in one case. Two patients underwent subsequent resection and one patient underwent stereotactic electroencephalogram (SEEG)-guided thermocoagulation. One patient had transient postsurgical paralysis over the left extremities. The changes of motor, speech and memory functions for these patients were consistent with the results of eSAM-Wada. Two patients had seizures, which might be related to the rapid intravenous administration of etomidate in the procedure. After prolonging the administration time to >30 s, the remained two patients had no seizures. Conclusion eSAMWada is a reliable and relatively safe method for comprehensive evaluation of motor, speech and memory functions in epilepsy surgery. Combined with vascular superselective technology, it can provide more effective guidance for craniocerebral surgery involving functional areas. |
| Key words: etomidate speech and memory assessment Wada test epilepsy |
