开颅手术中锥体束移位的探讨及应对策略  

Shift of pyramidal tract during craniotomy and its countermeasures

作　　者：王宇博[1] 马晓东[1] 许百男[1] 余新光[1] 孙国臣[1] 赵岩[1] 王飞[1] 宋志军[1] 赵溪[1] 梁永平[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《军医进修学院学报》2011年第6期560-562,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探索神经外科手术中锥体束的移位情况及应对策略。方法选择74例术前影像学诊断为额、颞及岛叶占位病变的病人,术前及术中应用MRI弥散张量成像(DTI)技术进行扫描,传入神经导航工作站进行锥体束的追踪描计,并对比术前及术中锥体束的位置。结果锥体束在前后方向方面25例发生向前移位,45例发生向后移位,4例无移位;锥体束在左右方向上32例发生向外移位,38例发生负向移位,4例无移位。结论在颅脑病变切除术中,锥体束的移位是普遍存在的,而且移位的方向及距离不具有可预测性,只有通过术中磁共振实时更新导航才能予以保护。Objective To study the pyramidal tract shift craniotomy and its countermeasures.Methods Seventy-four patients with frontal,temporal or insular lobe mass lesions were enrolled in the study.Preoperative and intra-operative diffusion tensor images（DTI） were obtained.The iPlan 2.6（Brain Laboratory,Feldkirchen,Germany） was used for reconstruction of the pyramidal tract and assessment of its shifting.Results Forward shifting,backward shifting,and no shifting of the pyramidal tract were found in 25,45 and 4 patients,respectively,while outward shifting,inward shifting,and no shifting of the pyramidal tract were found in 32,38 and 4 patients,respectively.Conclusion Pyramidal tract shift is common during craniotomy with its direction and distance unpredictable.Only by intra-operative updated real-time MRI navigation,can the shifting be prevented.

关 键 词：锥体束 术中磁共振 功能神经导航 脑移位 

分 类 号：R651.1[医药卫生—外科学]