功能神经导航及术中磁共振成像在语言区胶质瘤手术中的应用  

Functional neuro-navigation and intraoperative magnetic resonance imaging for the resection of gliomas involving eloquent language structures

作　　者：陈晓雷[1] 许百男[1] 王飞[1] 孟祥辉[1] 张军[1] 姜金利[1] 余新光[1] 周定标[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2011年第8期688-692,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30800349）;广东省科技计划资助项目（2008B030301077）

摘　　要：目的探讨功能神经导航及高场强术中磁共振成像（iMRI）在脑语言区胶质瘤手术中的临床应用价值。方法自2009年4月至2010年4月，48例语言区胶质瘤患者接受了功能神经导航及iMRI辅助下的手术。使用血氧水平依赖功能MRI（BOLD—fMRI）显示语言区皮层，同时采用弥散张量成像（DTI）技术重建弓形束，将上述语言功能结构图像融合后，导入导航系统，进行镜下神经功能导航，并利用iMRI进行术中肿瘤及功能结构影像的更新。术前、术后短期及长期随访时对所有患者进行语言功能评估。结果所有病例均成功实施了功能神经导航和iMRI扫描，12例发现病变残留并继续进行扩大切除，其中2例全切除。最终38例（79．2％）胶质瘤全切除，10例（20．8％）病变次全切除；全切除率从75．0％提高至79．2％。术后长期随访（3个月以上）结果显示，仅有1例（2．1％）高级别胶质瘤患者语言障碍程度较术前加重。无术后死亡及严重致残病例。结论功能神经导航及高场强iMRI系统能较好地定位语言区皮层及白质纤维束，准确评估病变切除范围，对语言区胶质瘤切除过程中语言功能结构的保留很有帮助。Objectives To explore the clinical value of functional neuro-navigation and high-field- strength intraoperative magnetic resonance imaging（iMRI） for the resection of intracerebral gliomas involving eloquent language structures. Methods From April 2009 to April 2010, 48 patients with intracerebral gliomas involving eloquent language structures, were operated with functional neuro-navigation and iMRI. Blood oxygen level dependent functional MRI （BOLD-fMRI） was used to depict both Broca and Wernicke cortex, while diffusion tensor imaging （DTI） based fiber tracking was used to delineate arcuate fasciculus. The reconstructed language structures were integrated into a navigation system, so that intra-operative microscopic-based functional neuro-navigation could be achieved, iMRI was used to update the images for both language structures and residual tumors. All patients were evaluated for language function pre- operatively and post-operatively upon short-term and long-term follow-up. Results In all patients, functional neuro-navigation and iMRI were successfully achieved. In 38 cases （79. 2% ）, gross total resection was accomplished, while in the rest 10 cases （20. 8% ） , subtotal resection was achieved. Only 1 case （2. 1% ） developed long-term （more than 3 months） new language function deficits at post-operative follow-up. No peri-operative mortality was recorded. Conclusions With functional neuro-navigation and iMRI, the eloquent structures for language can be precisely located, while the resection size can be accurately evaluated intra-operatively. This technique is safe and helpful for preservation of language function.

关 键 词：神经导航 术中监测 术中磁共振 语言功能区 

分 类 号：R739.41[医药卫生—肿瘤]