Awaking Anaesthesia And Intraoperative Neurophysiological Techniques In Epilepsy Surgery Involved In The Language Areas

Objective To discuss the application of awaking anaesthesia and neurophysiological techniques in epilepsy surgery involved in the language areas.Methods9epilepsy patients were evaluated by symptomatology, neuroimaging and electrophysiological examination before surgery. The relationship between epileptogenic lesions and (or) epileptogenic focus and the language areas were confirmed by preoperative assessments in the patients. All the patients received Computed tomography (CT), Magnetic resonance imaging (MRI) and Video electroencephalography monitoring (VEEG) and6cases who received PET-CT examination,5cases received MEG examination, and4cases who received fMRI examination. Epileptogenic lension and(or) epileptogenic focus involved in language areas,2cases in the left frontable lobe who were involved in Broca language area,1case in the left temporal lobe who were involved in Wernicke language area and6cases in both who were involved in Broca language area and Wernicke language area. The language function of patients was evaluated by BDAE aphasia classification.9patients were trained by language task for wake-up. All patients were undergone surgery assisted with neuron-navigation system and larynx mask and intravenous propofol. Electrocorticography recordings (ECoG) were adopted to confirm the epileptiform discharge area. Subsequently, we woke up patients witnout propofol and then cortical electrical stimulation (CES) was performed to locate the language areas. The stimulus intensity started from1mA, and with1mA or2mA increments, but the maximum was not more than15mA. The epileptic discharge areas and the language areas will be marked. If the lesiongs or foci in the language areas, we can choose bipolar coagulation technique or multiple subpial transections (MST), if not, we removed the epileptogenic lesions and the epileptic foci.The process was repeated until the spikes disappeared or significantly decreased. The results were observed for3to24months after the surgery. Observation includes reservations of the language function, the improvement in seizures and completeness of the epileptogenic lesions and/or the epileptic foci resection. Results The epileptogenic lesions and (or) the epileptic foci were involved in Broca area in8patients, and all of them have a definit positive language area. The epileptogenic lesions and/or the epileptic foci were involved in Wernicke area in7patients, but5cases have a definit positive language area.1cases occurred symptoms of motor aphasia in the first day of postoperative, but the others had not (3cases were BDAE4grade and5cases were BDAE5grade). However,3cases showed mixed aphasia from the second day of the postoperative on (1case was BDAE3grade and2cases were BDAE2grade), and through enhance dehydration and neurotrophic treatment, the symptom was recovery after2weeks of the postoperative. The language function of the9patients were related in postoperative3months.8patients had recovered to the preoperative level (BDAE5grade) but only1case had left partial motor aphasia (BDAE1grade). All patients had intravenous infusion of antiepileptic drugs, and a gradual transition for oral administration1or2antiepileptic drugs.9patients were followed up for3to24months. According to Engel seizure control efficacy standards:6cases reached to I level;2cases reached to Ⅱ level;1cases reached to Ⅲ level.Conclusion The application of awaking anaesthesia and neurophysiological techniques in epilepsy surgery involved in the language areas is a reliable, precise and safe mothod, which could allow a maximum remove of the epileptic lesions and/or the epileptic foci and protection of the language function effectively and improve the life quality of the patiens.