DEMARCATION AND LOCALIZATION OF PRIMARY SENSOR AND MOTOR AREAS IN HUMAN CORTEX BY CORTICAL SOMATOSENSORY EVOKED POTENTIAL (CO-SEP) DURING OPERATION IN SURGERY FOR EPILEPSY AND INTRACRANIAL TUMOR

使用大腦皮質軀體感覺誘發電位（Co－SEP）於Epilepsy及腦腫瘤手術中定位原始感覺區與運動區及中央溝

謝仁俊(Jen-Chuen Hsieh)；李德譽(Tak -Yu Lee)；施養性(Yang-Hsin Shih)；黃隸楝(Li-Dorig Hwang)；呂炳榮(Ping-Wing Lui)

Epilepsy surgery ； Sensorimotor evoked potential ； Somatosensory area ； Second sensory area

Acta Anaesthesiologica Sinica

28卷3期（1990 / 09 / 01）

285 - 293

英文

神經外科手術中若病兆位置靠近原始運動皮質區與感覺皮質區，則確切定位這些重要功能區域以避免醫源性創傷造成永久性併發症乃益形重要。本實驗依此主旨探討大腦皮質軀體誘發電位（Co-SEP）於腦腫瘤及Epilepsy患者手術中監測之可行性。本實驗研究8位麻醉分類II-III因腦腫瘤或Complex partial seizure而接受神經外科手術之病患其Co-SEP之變化。我們於正中神經給與電刺激而於大腦皮質利用Subdural grid記錄誘發電位並尋找位相倒置（Phase reversal pattern）以定位大腦皮質中央溝。所有病患皆可記錄到誘發電位。其中，於一腫瘤病人同時記錄到第二軀體感覺誘發皮質電位。結果顯示Co-SEP於本實驗全身麻醉之方式下其術中偵測之可行性不受影響。我們認為Co-SEP應該使用在神經外科手術中，尤其當病兆靠近中央溝，以增進病人手術及麻醉之安全。

In neurosurgical operation, when the focus is close to the central fissure, precise delineation of the precentral motor and postcentral somatosensory areas is cardinal in defining the extent of the surgical resection. Eight ASA II-III patients scheduled for neurosurgery for intractable complex partial seizure (n=5) and intracranial tumor (n=3) were enrolled in the study. Subdural grids of electrodes were used for recording cortical evoked somatosensory potentials elicited by stimulating the median nerve s to locate the primary somatosensory cortex and to delineate the central fissure through demonstration of phase-reveral pattern across the rolandic fissure. In all cases under general anesthesia, we were able to determine precisely the location of the central fissure. At the same time, we detected the evoked potential from SII (second sensory area) in one patient with intracerebral tumor. In conclusion, Co-SEP under general anesthesia is feasible and recommended to be performed as a routine intraoperatively for intractable epilepsy and tumor originating close to the primary motor or sensory strip in order to avoid iatragenic damage to the vital cerebral cortex.