功能磁共振导航辅助锁孔手术治疗脑皮质运动区占位性病变(附10例分析)  

Intraoperative functional magnetic resonance image-based neuronavigation in keyhole surgery for brain space-occupying lesions involving the motor cortical area:an analysis of 10 cases

作　　者：刘涛[1] 贡志刚[1] 蒋震[2] 张彩元[2] 沈钧康[2] 兰青[1] 

机构地区：[1]苏州大学附属第二医院神经外科,江苏苏州215004 [2]苏州大学附属第二医院影像科,江苏苏州215004

出　　处：《中国微侵袭神经外科杂志》2009年第1期14-17,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：江苏省社会发展计划(编号:BS2005023)

摘　　要：目的探讨功能磁共振导航(fMRI)辅助锁孔手术治疗脑皮质运动区占位性病变的临床价值。方法回顾性分析10例涉及脑皮质运动区占位性病变的手术情况。术前均行fMRI扫描,将图像输入史赛克导航系统后指导锁孔手术入路的设计;术中根据运动激活区与病变的关系,实时利用导航引导手术切除病变。结果病变全切除8例(80%),次全切除1例,部分切除1例。术后出现一过性肌力障碍加重4例,其他病人肌力水平同术前。术后3个月随访,肌力水平较术前均无恶化,且其中2例较术前改善。结论fMRI导航辅助锁孔手术治疗皮质运动区占位性病变,在最大程度切除病变的同时能有效保护神经功能,从而提高手术安全性,减少手术并发症,改善病人术后的生活质量。Objective To explore the clinical significance ofintraoperative functional magnetic resonance image （fMRJ）-based neuronavigation in keyhole surgery for brain space-occupying lesions involving the motor cortical motor area. Methods Ten cases of the patients with brain space-occupying lesions involving the motor cortical area were analyzed retrospectively. Preoperatively fMRI was conducted in all the patients, then fMRI data were input to the neuronavigation system （Stryker navigation system） to design suitable keyhole approaches. Intraoperatively, careful resection was performed according to the real-time identified spatial relationship between the motor area activation and the brain space-occupying lesions by the navigator. Results The lesion was totally resected in 8 cases, subtotal in 1 and partial in 1. Transient attenuation of the muscle strength postoperatively occurred in 4 cases, while the muscle strength level in other patients was the same as preoperation. After 3 months of follow-up, all patients did not present with any neurological deterioration, while muscle strength was enhanced in 2 cases. Conclusion fMRI neuronavigation in keyhole surgery for brain space-occupying lesions involving the motor cortical area is a minimally invasive way to maximize tumor resection and effectively protect neurological functions simultaneously, which will be beneficial in increasing the safety of surgery, decreasing the operative complications and improving the postoperative quality of life in the patients.

关 键 词：磁共振成像 神经导航 锁孔手术 运动皮质 

分 类 号：R739.4[医药卫生—肿瘤]