应用脑磁图合成孔径磁场测定技术进行运动功能区和致痫灶定位的研究  

Application of Magnetoencephalography with Synthetic Aperture Magnetometry in Localization of Motor Cortex and Epileptogenic Focus

作　　者：张宁[1] 乔慧[2,3] 王拥军[1] 孙波[2,3] 冯毅刚[2,3] 舒宁[2,3] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京市100050 [2]首都医科大学附属北京天坛医院脑磁图中心,北京市100050 [3]北京市神经外科研究所,北京市100050

出　　处：《中国康复理论与实践》2008年第11期1048-1051,共4页Chinese Journal of Rehabilitation Theory and Practice

基　　金：国家自然科学基金资助项目(30571899)

摘　　要：目的利用脑磁图(MEG)的合成孔径磁场测定(SAM)技术对中央沟附近病变进行运动功能区和致痫灶定位研究,评估SAM技术在脑功能区病变和癫痫手术中的应用价值,明确MEG的空间定位优势。方法对12例中央沟附近病变(其中6例合并癫痫)的患者术前进行Karnofsky生活状态评分(KPS),采用SAM技术确定颅内病变、运动功能区和致痫灶的位置关系,指导手术方案的制定。术中通过诱发电位监测和皮质及深部脑电监测,术后通过随访复测KPS评分和癫痫发作情况,明确SAM技术定位的准确性。结果本研究的12例患者运动诱发磁源成像均定位于中央前回附近,6例合并癫痫的患者致痫灶定位结果均与术中脑电图监测一致,所有患者根据SAM定位结果确定手术方案和指导手术进行。8例患者KPS评分改善,运动功能有所恢复;所有患者均没有额外的功能损害发生。6例癫痫患者中有5例癫痫控制良好,1例患者癫痫控制不佳。结论SAM技术可以对功能区和致痫灶进行精确定位,同时可以明确颅内病灶与功能区和致痫灶的位置关系,指导手术治疗方案,控制癫痫,减少术后残疾的发生率。Objective To investigate the value of synthetic aperture magnetometry （SAM） in localizing motor cortex and epileptogenic focus for brain lesions near the central sulcus and to clear its advantage in the localization. Methods 12 patients （6 patients with epilepsy） were enrolled in this study. Before the operation, the patients were all taken Karnofsky Performance Status Score （KPS）, examined with MEG by SAM technique in the localization of motor cortex and epileptogenic focus to determine their position relationship, and guide the scheme of surgery programme. During the operation, the location of hand-motor functional area were identified with evoked potential monitoring awaking test, and epileptogenic focus with electrocorticogram （ECoG） monitoring. The accuracy of location was assessed with the hand movement and KPS score, and the epileptic attack were evaluated with Engel curative effect grading. They were followed up for 2 years. Results The motor cortex of all the patients were located near the precentral gyrus with SAM and the localization of epileptogenic focus in 6 patients by SAM was consistent with that by ECoG. All the operations were based on and guided by the SAM. After the operations, the motor function and KPS score of 8 patients improved. No extra functional lesions happened in all patients. Epilepsy was well controlled in 5 cases. Conclusion SAM can correctly localize the motor cortex and epileptogenic focus. Meanwhile position relationship between the intracranial lesions and motor functional areas and epileptic focus can be clear. It is a valuable method for surgical planning and epilepsy controlling and will decrease the occurrence of neurological deficits after operation.

关 键 词：脑磁图 合成孔径磁场测定法 运动功能区 癫痫 致痫灶 

分 类 号：R742.1[医药卫生—神经病学与精神病学]