术中磁共振和功能神经导航在语言功能区病变手术的应用  

Application of intraoperative magnetic resonance imaging and functional neuronavigation in microsurgery for lesions near language-related brain regions

作　　者：王飞[1] 陈晓雷[1] 孙正辉[1] 赵岩[1] 孙国臣[1] 王宇博[1] 宋志军[1] 许百男[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《南方医科大学学报》2011年第5期805-809,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(30800349);广东省科技计划项目(2008B030301077)~~

摘　　要：目的探讨术中磁共振和功能神经导航在语言区病变手术中的应用价值。方法 61例右利手患者在术中磁共振和基于血氧水平依赖和弥散张量成像技术的功能神经导航辅助下实施语言功能区病变手术,按部位分为A组(左额下回后部附近病变)和B组(左颞上回后部附近病变),术前及术后2周用西方失语症成套试验对所有患者进行语言评估,获得失语指数(AQ)。结果 AQ术前正常者(AQ≥93.8)33例,AQ术后与AQ术前对比无统计学差异(P>0.05),AQ术前低于正常者28例,AQ术后较术前对比有所提高(P<0.01)。术后2周时,14例(23.0%)出现语言功能下降,仅有2例(3.2%)在6个月随访时仍存在语言功能障碍。41例获得全切除,20例获得次全切除,AQ变化值(ΔAQ=AQ术后-AQ术前)与病变切除程度无关,A组ΔAQ高于B组。结论术中磁共振和功能神经导航技术能够较好显示病变与语言相关皮层及纤维束之间的关系,有助于语言功能区病变患者术后语言功能的保留。Objective To explore the clinical value of intraoperative magnetic resonance imaging（MRI） and functional neuronavigation in the preservation of the language function during microsurgery for lesions near language-related brain regions.Methods Sixty-one right-handed patients underwent microsurgical resection of the lesions near the language-related brain regions with the assistance of intraoperative MRI and blood oxygen level-and diffusion tensor imaging-based functional neuronavigation.The patients were divided into 2 groups according to the location of the lesions,namely group A with lesions near the left posterior inferior frontal gyrus and group B with lesions near the left posterior superior temporal gyrus.The aphasia quotient（AQ） of all patients were obtained using Western Aphasia Battery（WAB） before and 2 weeks after the operation.Results In the 33 patients with a normal AQ score（≥93.8） before the operation,the AQ score underwent no significant changes after the operation（P0.05） .Twenty-eight patients had lowered AQ scores（93.8） preoperatively,which were improved significantly after the operation（P0.01） .At 2 weeks after the operation,the language function worsened in 14 patients（23.0%） ,and only 2（3.2%） showed a persistent language deficit at 6 months.Of the 61 patients,radical resection of the lesions was achieved in 41 and subtotal resection in 20 patients.The variation of AQ scores after the operation was not found to correlate to the degree of lesion resection,and the patients in group A showed a greater AQ variation than those in group B.Conclusions Intraoperative MRI and functional neuronavigation can well demonstrate the structural relations between the lesions,the cortical areas and the fasciculi related to language functions,thus helping to better preserve the language function during microsurgical lesion resection in patients with lesions near language-related brain regions.

关 键 词：术中磁共振 功能神经导航 血氧水平依赖功能磁共振成像 弥散张量成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]