术中功能定位切除辅助运动区低级别胶质瘤  

Intraoperative functional mapping for surgery of low-grade gliomas located in supplementary motor

作　　者：张忠[1] 江涛[1] 谢坚[1] 刘福生[1] 陈新忠[2] 乔慧[1] 李子孝[3] 陈忠平(点评)[4] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100050 [2]首都医科大学附属北京天坛医院麻醉科,北京100050 [3]首都医科大学附属北京天坛医院神经内科,北京100050 [4]广东省中山大学肿瘤医院神经外科

出　　处：《中华神经外科杂志》2008年第1期35-38,共4页Chinese Journal of Neurosurgery

基　　金：十一五国家科技支撑计划（2007BA105808）;首都医学发展科研基金（2005-2024）

摘　　要：目的探讨辅助运动区低级别胶质瘤的手术方法。方法回顾性分析14例辅助运动区低级别胶质瘤患者的临床资料和随访结果。术前应用功能磁共振进行评价。应用术中超声确定解剖边界，在唤醒麻醉下应用皮质电刺激定位功能边界，根据解剖-功能边界切除肿瘤。评价患者术前、术后功能结果。结果术后24h复查MRI显示肿瘤全切12例，大部切除2例。术后病理显示星形细胞瘤5例，少枝细胞瘤6例，少枝-星形细胞瘤3例。术后2例出现典型的辅助运动区综合征，3例出现部分辅助运动区综合征。随访12个月所有患者预后良好。结论唤醒麻醉下应用术中皮质电刺激，确定肿瘤切除的功能边界。根据解剖-功能边界切除肿瘤，能够最大程度切除辅助运动区低级别胶质瘤，同时保护正常的运动功能。Objective To investigate the surgical treatment for low-grade gliomas involving the supplementary motor area. Methods Clinical data and follow-up outcome of 14 patients with low-grade gliomas involving the supplementary motor area were analyzed retrospectively. The preoperative founctional MRI was performed in all patients preoperatively to determine the relationships between the supplementary motor area, the primary motor areas and the tumor. The intraoperative ultrasound was used to delineate the anatomical limits. Under awake anaesthesia, all patients underwent cortical and subcortical founctional mapping via the intraoperative direct cortical electrical stimulation to determine functional boundaries of tumors. The tumors were removed according to anatomic-functional boundaries. Preoperative and postoperative functional results were evaluated. Results The enhanced MRI performed within 24 hours postsurgery showed total resection in 12 cases, subtotal resection in 2 cases. The histological results of all patients revealed astrocytoma in 5 cases, oligodendroglioma in 6 cases, oligoastrocytoma in 3 cases. Two patients developed complete supplementary motor area syndrome and three patients developed partial supplementary motor area syndrome postoperatively. All 14 patients had excellent outcomes at the 12-month follow-up examination. Conclusion Under awake anaesthesia, intraoperative cortical electrical stimulation deciding functional border of the tumor resection can excise low-grade gliomas involving the supplementary motor area as much as possible with the preservation of normal motor function.

关 键 词：辅助运动区 低级别胶质瘤 皮质电刺激 神经外科手术 

分 类 号：R739.4[医药卫生—肿瘤]