高场强术中磁共振结合语言功能神经导航技术在胶质瘤手术中的应用  

The use of high-field intra-operative magnetic resonance imaging combined with language functional neuronavigation in glioma surgery

作　　者：赵岩[1] 陈晓雷[1] 王飞[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：《解放军医学杂志》2011年第7期697-700,共4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：目的探讨高场强术中磁共振系统与语言功能导航技术联合应用对优势大脑半球语言功能区胶质瘤手术切除效果的影响。方法收集2009年2月-2010年7月与优势大脑半球弓形束关系密切的胶质瘤患者20例,男12例,女8例,年龄2061岁,平均43.6岁,根据术前失语评分（AQ）将患者分为语言功能正常组（n=9）和语言功能障碍组（n=11）。所有患者均接受高场强术中磁共振及弓形束导航辅助下手术,采用1.5T移动磁体、双室设计的术中磁共振系统,术前通过软件将弓形束重建的3D图像整合入神经导航系统,并在术中联合应用显微镜下功能神经导航。术前及术后24周、36个月进行随访（包括MRI检查及西方失语成套测验）。结果 20例患者均完成术前及术中弓形束重建,将3D重建图像整合入神经导航系统后成功实现了显微镜下导航。术后24周,语言功能正常组AQ（94.5±5.5）保持在正常水平,只有1例出现新发的传导性失语症状（AQ=81.8）,而语言功能障碍组AQ（89.4±5.8）与术前比较（84.9±8.7）有明显改善（P〈0.05）。术后36个月,语言功能正常组中除2例因肿瘤复发出现语言功能恶化外,其余患者AQ（98.3±0.5）均在正常范围,而语言功能障碍组AQ（95.2±2.6）较术后24周也有了明显改善（P〈0.05）。两组患者术后均未出现其他新的神经功能障碍,无死亡病例。结论高场强术中磁共振结合功能神经导航是一项可靠、稳妥的技术,在肿瘤毗邻重要语言功能区及传导束时,可辅助外科手术最大限度地切除肿瘤,减轻神经功能损伤,有利于术后功能恢复。Objective To explore the effect of high-field intra-operative magnetic resonance imaging（iMRI） combined with language functional neuronavigation in resection of glioma in language area of dominant hemisphere of the brain.Methods Twenty right handed patients（12 males and 8 females,aged from 20 to 61 years with mean of 43.6 years） with glioma close to arcuate fasciculus were involved in present study,and they were stratified into normal group（n=9） and aphasia group（n=11） according to the preoperative aphasia quotient（AQ）.All the patients underwent surgical operation assisted by arcuate fasciculus navigator,and the high-field iMRI was performed with a 1.5-T magnetic resonance scanner.The 3D reconstructed arcuate fasciculus images were integrated into neuronavigation system before the operation,and used by combining with functional neuronavigation under microscope during the surgical procedure.Pre-operatirely,and 2-4 weeks,3-6 months postoperative,the patients were examined with magnetic resonance scanning and aphasia quotients examination.Results Pre-operative and intra-operative arcuate fasciculus reconstruction was completed in all the 20 patients,and neuronavigation under microscope were performed after the 3D images integrated into neuronavigation system.Patients of normal AQ（94.5±5.5） retained the normal level,except one patients who developed new conduction aphasia syndrome（AQ=81.8） 2-4 weeks after operation.The AQ of aphasia group（89.4±5.8） was significantly improved than that before operation（84.9±8.7,P〈0.05）,except 2 patients whose language deficit was exacerbated due to tumor recurrence.The AQ of normal group（98.3±0.5） remained at normal level,while that of aphasia group（95.2±2.6） was significantly improved 3-6 months after operation compared with that at 2-4 weeks after operation（P〈0.05）.There were no other new neurologic deficits and death in both groups.Conclusion High-field iMRI combined with functional neuronavigation is a safe and reliable tech

关 键 词：磁共振成像 弓形束 神经胶质瘤 神经导航 

分 类 号：R651.110.5[医药卫生—外科学]