手术是脑内可切除性病变,尤其是脑肿瘤的首选治疗方法之一。然而,由于许多肿瘤具有侵袭性,尤其是(低级别)胶质瘤,病灶常侵犯脑功能区;另外由于个体之间存在解剖和功能的变异,故需应用脑功能定位方法定位脑功能区皮质及皮质下边界,用以个体化指导切除范围。除术前可采用功能成像(fMRI)进行术前计划外,切除肿瘤过程中还可应用术中电刺激,当需定位病人的语言区和其他认知功能区时,可使用局部麻醉。术中电刺激是一种确定脑功能区皮质及皮质下结构简单、准确、可信度高的安全方法,具有以下特点:①切除肿瘤前可定位每一个病人的功能区皮质;②了解被病灶侵犯区域,如辅助运动区、岛叶、运动前皮质、缘上回及角回的的病理生理功能;③在整个切除病灶过程中,可持续定位皮质下结构,用以了解解剖与功能的联系(皮质-皮质环及皮质-皮质下环路);④利用皮质重复电刺激可实时研究短期可塑性机制;⑤可根据功能界线进行病灶切除,以最大程度切除病灶,并尽量减小术后永久性功能障碍的风险,提高效益/风险比。此外,术中电刺激还可与围手术期各种功能神经影像技术相结合,如fMRI、PET、脑磁图(MEG)、矢量专题信息(digitalthematicinformation,DTI),用以提高术前计划的可靠性,帮助了解因肿瘤生长及手术切除过程中短期和长期内功能区 Surgery is one of the first choice of treatment of intracranial resectable lesions, especially brain tumors. However, since many tumors are invasive, especially (low grade) gliomas, the lesions often invade the brain’s functional areas. In addition, due to the existence of anatomical and functional variations among individuals, brain localization of the brain functional areas And subcortical border, to guide the individual removal of the scope. In addition to preoperative planning with functional imaging (fMRI), intraoperative electrical stimulation may be used during tumor resection and local anesthesia may be used when locating the patient’s speech area and other cognitive function areas. Intraoperative electrical stimulation is a safe method to determine the structure of brain function area cortical and subcortical simple, accurate and high credibility, has the following characteristics: ① resection of tumor can locate each patient’s functional cortex; ② understanding of the lesion Invasion of the region, such as the auxiliary exercise area, insula, pre-motor cortex, margin margin and the angle of the pathophysiology; in the entire removal of the lesion, the sustainable positioning of the subcutaneous structure to understand the relationship between anatomy and function (Cortex - cortical ring and cortical - subcortical loop); ④ the use of cortical repeated electrical stimulation can be a real-time study of short-term plasticity mechanism; ⑤ according to the functional boundaries of the lesion to remove the lesion to a maximum extent and minimize postoperative permanent Risk of dysfunction and increase benefit / risk ratio. In addition, intraoperative electrical stimulation can also be combined with various perioperative functional neuroimaging techniques such as fMRI, PET, MEG, and digitalthematicinformation (DTI) to improve the reliability of preoperative planning Help to understand short and long term functional areas due to tumor growth and surgical resection