电生理监测在中央回及其相邻区域胶质瘤手术中的临床应用  

Clinical application of electrophysiologic monitoring in surgical treatment of glioma locating in gyri centrales or the adjacent area

作　　者：张广健[1] 杨卫东[1] 毓青[1] 王增光[1] 刘阳[1] 陈旨娟[1] 苗兴路[1] 孙即奎[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中国现代神经疾病杂志》2011年第6期620-626,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划基金项目(项目编号:06YFJMJC07900)

摘　　要：目的探讨应用皮质体感诱发电位、皮质运动诱发电位和皮质脑电图定位功能区,提高毗邻脑功能区胶质瘤切除手术的有效性和安全性。方法通过影像学检查筛选18例中央回及其毗邻部位的胶质瘤患者,经功能磁共振成像和脑磁图初步定位功能区;术中以皮质体感诱发电位和运动诱发电位进一步确定脑功能区、脑电图明确致癎灶位置,避开功能区切除肿瘤和(或)致癎灶;术后于瘤腔内植入放射性同位素^(125)Ⅰ和缓释型化疗药物5-氟尿嘧啶。结果 18例患者中1例肿瘤全切除、13例次全切除、4例部分切除。手术后第6、12和24个月疗效评价,无进展生存期平均为11个月;客观有效率分别为13/1 8、9/18和6/18;疾病控制率15/18、13,18和10/18。手术前和术后第6、12、24个月时的Karnofskv生活质量评分分别为(84.13±12.88)、(78.20±15.13)、(62.35±13.21)和(46.57±16.93),各观察时间点之间比较差异有统计学意义(P<0.01)。术后并发症发生率为6,18例(肌力下降2例、感觉减退3例、肌力与感觉同时减退1例)。结论采用术中神经电生理学监测方法定位功能区及致癎灶,可在保留功能的情况下指导切除中央回及其毗邻部位胶质瘤。术后瘤腔内行间质放化疗对延长患者生存期、减少肿瘤复发有一定临床意义。Objective To explore the application of cortical sensory evoked potential （Co-SEP）, motor evoked potential （Co-MEP） and eleetrocorticogram （ECoG） for locating functional area to enhance the effectiveness and safety of glioma resection. Methods Eighteen cases of glioma located in or adjacent to the gyri centrales were screened by ieonography, fMRI and magnetoeneephalography （MEG） were used to locate functional area. During operation, the Co-SEP and Co-MEP were performed to further define the functional area, and ECoG was performed to detect the epileptogenic focus. The glioma was removed as much as possible, avoiding the invasion of brain functional area. 125I and 5-FU were embeded in the tumor bed during operation. Results In 18 cases, one case was total reseeted; 13 cases were subtotal resected; 4 cases were partial reseeted. The curative effect was evaluated at 6 months, 12 months, and 24 months after operation. Progression-free survival （PFS） was 11 months on the average. Objective effective rate was 13/18, 9/18 and 6/18, respectively. Disease control rate （DCR） was 15/18, 13/18 and 10118, respectively. Karnofsky Performance Scale Score at preoperation and 6 months, 12 months and 24 months after operation was （84.13 ± 12.88）, （78.20 ± 15.13）, （62.35 ±13.21） and （46.57 ± 16.93） respectively, and the differences were all significant （P 〈 0.01）. Incidence rate for post-operative complication was 6/18 （2 cases with hypomyodynamia, 3 case with hypoesthesia, and one case with both）. Conclusion Neuro -electrophysiologic monitoring guided surgery of glioma located in or adjacent to the gyri centrales is effective for the resection of glioma as much as possible, avoiding the invasion of important functional area,and can improve patient＇s quality of life. After gloma resection, application of interstitial radiotherapy combined with chemotherapy may extend patient＇s life span, and decrease the recurrence of glioma.

关 键 词：神经胶质瘤 诱发电位 躯体感觉 诱发电位 运动 脑电描记术 监测 手术 中 大脑皮质 

分 类 号：R739.4[医药卫生—肿瘤]