3．0T术中磁共振成像引导下唤醒麻醉联合术中语言皮质定位技术在语言区脑胶质瘤手术中的应用  

Awake craniotomy and intraoperative language cortical mapping for eloquent cerebral glioma resection： preliminary clinical practice in 3. 0 T intraoperative magnetic resonance imaging integrated surgical suite

作　　者：路俊锋[1] 章捷[1] 吴劲松[1] 姚成军[1] 庄冬晓[1] 邱天明[1] 龚秀[1] 许耿[1] 毛颖[1] 周良辅[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200050

出　　处：《中华外科杂志》2011年第8期693-698,共6页Chinese Journal of Surgery

基　　金：卫生部临床学科重点资助项目（2010-2012年度）;国家自然科学基金资助项目（81071117）

摘　　要：目的评价3．0T术中磁共振成像（iMRI）下采用唤醒麻醉联合术中语言皮质定位技术辅助语言区脑胶质瘤切除的临床有效性。方法2010年12月至2011年4月以集成3．0TiMRI数字一体化神经外科手术中心为平台，采用唤醒麻醉、改良手术铺巾技术、联合直接电刺激语言皮质定位和iMRI实时影像神经导航，对11例右利手患者实施左侧语言区脑胶质瘤切除。术中采用简易语言任务模式，包括语言流利度、图片命名和文字阅读，评估患者语言功能状况。围手术期采用汉语失语检查法，评估新技术的临床有效性。结果通过iMRI实时影像导航，6／11的患者可以定量提升胶质瘤切除范围，其中影像学全切除率提高3／11，最终肿瘤全切除7例，次全切除4例。语言皮质定位阳性率为8／11。患者术后1周内出现一过性失语率为4／11，随访至术后1个月，所有患者语言功能均恢复到术前水平或以上；围手术期患者无肢体运动功能障碍。结论应用3．0T超高场强iMRI实时影像导航可在术前设计脑胶质瘤个体化手术方案，术中精确定位病灶，等体积定量切除肿瘤，提高肿瘤切除率；在唤醒麻醉下实施术中皮质电刺激定位语言区，能最大程度保护患者语言皮质，避免出现不可逆的语言功能损伤，提高术后社会生活质量。Objectives To evaluate preliminary clinical experience for combining awake craniotomy and intraoperative language brain mapping within the integrated 3.0 T intraoperative magnetic resonance imaging （iMRI） suite. Methods From December 2010 to April 2011,11 right hand-dominant patients with left glioma were involved in, or adjacent to, eloquent cortex was carried out awake craniotomies with cortical stimulation within an integrated 3.0 T iMRI suite. Aphasia battery of Chinese was used to test the language function before the operation. During the procedure, after the occipital, temporal, and supraorbital nerves were blocked by the anesthesiologists, the head was fixed with a custom high-field MRI-compatible head holder. The skull and dura was opened as usual and language brain mapping was then performed. Language testing followed a set protocol： counting numbers from 1 to 50, naming objects, reading single words. Resection of the tumor was guided by neuronavigation system and continued until eloquent areas were encountered or the margin of assessment was reached. An interdissection MRI was aquired to evaluate the glioma removal in a movable MRI scanner after minimal draping. Meanwhile, adverse effects caused by electrical stimulation and iMRI were recorded. The follow-up speech tests were assessed on 7th day and 1 month at least after the operation. Results The combined use of 3.0 T iMRI and awake craniotomy was performed safely in all patients. No adverse effects were reported. The duration of surgery was prolonged by 2 to 4 h. The patients＇ perception of iMRI during surgery was favorable. First-look MRI studies led to further resection attempts in 6/11 cases as well as a 3/11 increase in the number of gross-total resections. One week after surgery, baseline language function worsened in g cases. However, no patients had a persistent language deficit one month after surgery. Conclusions Awake craniotomy and direct cortical electrical stimulation can be performed safely and effectively within a 3.0 T iMRI s

关 键 词：神经导航 电刺激 术中磁共振 语言皮质定位 唤醒麻醉 

分 类 号：R651.11[医药卫生—外科学]