最新の覚醒下脳神経外科手術—リハビリテーション科と脳神経外科のコラボレーション

Awake Neurosurgery in Collaboration with Rehabilitation

はじめに

　脳神経外科とリハビリテーション（以下，リハ）の医療連携，というと脳卒中や外傷等による後遺症に対する治療を想起するのが一般的である．リハ科での評価方法と治療方法・効果の進歩には我々脳神経外科医師が驚くものがあり，術前術後の検討会やその学問的基盤から共同研究を行っている脳神経外科も増えてきた．本稿では我々が行っているユニークな治療連携として，最新の覚醒下脳神経外科手術におけるリハ科と脳神経外科のコラボレーションを紹介する．

Abstract : Evaluations of brain function pre- and intra- operatively has been essential to maintain the quality of life in patients undergoing neurosurgery. These evaluations, which have been developed through studies in epilepsy, are now essential in neurosurgery for brain tumors and vascular diseases. The goal of functional brain mapping followed by function monitoring, is to perform surgery more safely and effectively thereby allowing for better outcomes. When choosing among multiple modern modalities for brain functional evaluation, we should consider the physiological aspects of each of these methods from a view point of functional recovery or compensation. Clinical usefulness and differences between intraoperative electrical stimulation of the cortex and subcortical fibers and clininical symptoms under an awake state to preserve affected or unaffected function during neurosurgery are also discussed. Further consideration of the actual network connecting each eloquent area may ultimately lead to a new concept in neurosurgery as well as in neuroscience itself.