脑磁图在大脑感觉运动功能区占位性病变患者中的应用  

The application of magnetoencephalography in patients with lesions in cortical sensory and motor area

作　　者：邵卫国[1] 李明荣[1] 陈蕾[1] 李卫娜[1] 吴南[1] 吴国材[1] 

机构地区：[1]第三军医大学西南医院神经外科,全军神经系统疾病微创诊治专科中心,重庆400038

出　　处：《癫痫与神经电生理学杂志》2010年第5期273-276,共4页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨脑磁图（MEG）在大脑皮层感觉、运动功能区占位性病变患者中的应用价值.方法：对81例大脑皮层感觉和（或）运动功能区及其附近占位性病变患者,应用151信道全头型MEG系统,通过电流刺激正中神经和胫神经确定上、下肢体感皮层的位置,运动皮层分别通过双手食指按压键盘引起的MEG反应来定位.术前将磁源性影像（MSI）通过神经影像导航进行三维重建,了解相应功能区与病变的解剖关系,设计手术入路.感觉功能区病变患者和运动功能区不能确定的患者术中通过电刺激正中神经（或胫神经内踝）使用皮层电极于拟定的中央沟前后的皮层记录体感诱发电位（CSEP）,依据中央沟前后皮层记录到的CSEP具有极性反转的特征来确定中央沟.其中8例患者通过对指运动行功能磁共振（fMRI）检查,在术中唤醒状态下通过电刺激大脑皮层确定运动功能区.结果：81例患者全部定位出感觉功能区,75例患者定位出运动功能区,6例患者因功能障碍或配合差运动功能区不能定位.术后1例患者病变对侧肢体运动障碍加重,其余80例患者无感觉、运动功能损害.结论：术前行MEG功能区定位有助于医生选择合适的手术入路和避免术中损伤脑功能区皮质,最大限度地保护神经功能,减少手术伤残率,提高手术疗效.Objective：To investigate the value of magnetoencephalography （MEG） in cortical sensory and motor area lesions. Methods： Eighty-one patients with lesions in or adjacent to sensory and （or） motor cortex received MEG examination by a CTF 151 MEG system. Somatosensory areas of both upper and lower limbs were located by electrical stimulus at median nerves and tibial nerves. Motor areas were located by a finger typing task. Magnetic source imaging （MSI） was rebuilt in tri-dimension before surgery and the surgery method was planned after awareness of relationship between functional area and lesions. Central suleus would be determined by sensory evoked potentials （CSEP） recorded by electrocorticogram in surgery if the patients had sensory area lessions or motor area couldn＇t be located. Motor areas of 8 patiens in our study were determined by fMRI and intraoperative wake-up electrical stimulus to cortex. Results： All the lessions of the 81 patients were located in sensory areas by MEG successfully, and of 75 patients in motor areas. Six patients couldn＇t be located because of their dysfunction or poor co-operation. Eighty patients had no sensory or motor dysfunction except 1 had permanent movement disorder in the contralateral side of the lesions. Conclusion： Presurgical functional mapping by MEG contrbate tosurgical plan and avoid injury in functional ares. which can do the best to protect nerve system, reduce disabilily rate and improve the surgical efficacy.

关 键 词：脑磁图(MEG) 脑皮层感觉功能区 脑皮层运动功能区 颅内占位性病变 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R739.41[医药卫生—临床医学]