初级皮质运动区和锥体束的可视化研究及应用  

Intra-operative visualization of primary motor cortex and pyramid tract:implementation and clinical experience

作　　者：王宇博[1] 陈晓雷[1] 王飞[1] 赵岩[1] 宋志军[1] 孙国臣[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：《解放军医学杂志》2011年第7期694-696,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(30800349);广东省科技计划(2008B030301077);北京市自然科学基金(7102145)

摘　　要：目的探讨基于血氧水平依赖功能磁共振成像（BOLD-fMRI）和弥散张量成像（DTI）的功能神经导航技术在神经外科手术中对脑功能区进行显微镜下可视化的可行性。方法连续收集2009年2月-2010年7月初级运动皮质及锥体束附近病变患者278例,男156例,女122例,年龄40.7±15.9（779）岁。278例中胶质瘤231例,转移瘤5例,脑膜瘤16例,海绵状血管瘤18例,动静脉畸形2例,血管内皮细胞瘤1例,生殖细胞瘤3例,淋巴细胞瘤2例,均在功能神经导航下行手术切除。术前应用BOLD-fMRI及DTI技术进行扫描,通过导航工作站重建手运动区和锥体束并将导航影像投射至手术显微镜,用于镜下导航。比较患者术前及术后的肌力、运动功能及KPS评分,并统计手术并发症发生情况。结果 278例患者中217例（78.1%）病变切除≥95%,246例（88.5%）病变切除≥90%,259例（93.2%）病变切除≥80%;术后1周内神经功能障碍加重发生率为22.3%（62/278）,随访16个月神经功能障碍发生率为6.8%（19/278）。结论在神经外科手术中应用fMRI及DTI结合功能神经导航对脑功能区进行显微镜下可视化是可行的,可最大限度地切除病变,减轻神经功能损伤,有利于术后功能恢复。Objective To explore the feasibility of neuronavigation based on blood oxygen level dependent functional MRI（BOLD-fMRI） and diffusion tensor imaging（DTI） for visualization of eloquent cortex in microscopic neurosurgery.Methods Two hundred and seventy-eight patients（156 males and 122 females,aged from 7 to 79 years with mean of 40.7±15.9 years） with space-occupying lesions involving the primary motor cortex and pyramidal tract hospitalized from Feb.2009 to Jul.2010 were involved in present study.Of the 278 patients,231 were with glioma,5 with metastatic tumors,16 with meningioma,18 with cavernous hemangioma,2 with arteriovenous malformation,1 with hemangioendothelioma,3 with germinoma and 2 with lymphocytoma,and all the tumors were resected under functional neuronavigation.The images of hand motor area and pyramidal tract were acquired by BOLD-fMRI and DTI before operation and reconstructed by navigation system,and then projected to the operating microscope for navigation under microscope.The muscle strength,motor function and Karnofsky Performance Scores（KPS） before and after operation were compared and the surgical complications were recorded.Results Of the 278 patients,217（78.1%） achieved a ≥95%,246（88.5%） of ≥90% and 259（93.2%） of ≥80% of resection.The neurological dysfunction was aggravated in 62 cases（22.3%） within 1 week after operation,and the neurological dysfunction was retained in 19 cases（6.8%） only during the follow-up period of 1 to 6 months.Conclusions The visualization of eloquent cortex in microscopic neurosurgery with BOLD-fMRI,DTI and functional neuronavigation was feasible,and it is helpful in maximizing the resection of lesions,minimizing neural injury and promoting post-operative recovery.

关 键 词：磁共振成像 神经导航 运动皮质 锥体束 神经外科手术 

分 类 号：R651.11[医药卫生—外科学]