导航辅助皮层功能拓扑定位在累及功能区致痫灶手术中的初步应用  

Preliminary topological trial in integrating brain mapping with 3D neuro - navigation for surgery involving eloquent cortex （ case report and literature review）

作　　者：赵晨杰[1] 徐纪文[1] 王桂松[1] 周洪语[1] 田鑫[1] 徐虎[1] 徐忠贤[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中华神经外科杂志》2011年第11期1086-1090,共5页Chinese Journal of Neurosurgery

基　　金：上海交通大学医工（理）交叉基金资助项目（YG2010MS30）;上海高校选拔培养优秀青年教师科研专项基金资助项目（JDY09023）

摘　　要：目的应用神经导航影像融合并结合皮层电刺激功能定位技术，初步实现三维可视化皮层功能拓扑定位，辅助累及皮层功能区致痫灶的手术，提高疗效。方法1例药物难治性癫痫患者，行双侧皮层电极埋藏覆盖中央区，术后予皮层脑电图监测，并实施皮层电刺激定位功能区。神经导航系统融合头颅MRI和CT影像，三维可视化拓扑定位皮层功能和致痫灶，第二次手术在导航辅助定位保护功能区的前提下，行致痫灶切除术，对累及功能区的病变实施皮层热灼术。结果患者成功埋藏32导、24导及6导皮层电极各一枚覆盖中央区，皮层脑电图监测捕获临床发作4次，定位致痫灶；皮层电刺激确定功能区。神经导航影像融合建立覆盖皮层电极的三维大脑模型，还原电生理资料，实现拓扑定位。手术成功实施病灶切除，术后无发作情况，无并发症。结论应用神经导航影像融合技术，使作为脑一机接口的脑皮层电极技术与影像学技术相结合，将皮层电极的空间位置，精确融合在基于头颅MRI建立的大脑皮层解剖模型上，还原皮层脑电图和皮层电刺激结果，实现三维可视化拓扑定位，对于累及功能区致痫灶的神经外科手术具有重要指导意义。Objective With the help of image fusion, a 3D model of cortex covered with cortical electredes was established. With that model, the electrophysiological information from the electrodes could be bound with gyri and sulci as point to point for analysis. A preliminary topological trial in clinical brain mapping was demonstrated, in order to improve the accuracy of localization and the outcome of surgery involving the eloquent cortex. Method One case of drug - resistant epilepsy was screened by long term video - EEG,localizing the epileptogenic zones around central areas without lateralization. There was no more valuable information could be supplied by imageology. Three subdural electrodes（4 x8 grid; 4 x6 grid; 1 x6 strip） were then implanted for covering bilateral central cortex for 4 days. The long term video - ECoG and electrocortical stimulation had been applied in this period for more information about the loci and cortical function. Based on the 3D model that establisbed by merging MRI and CT, the relationship between the foci and eloquent cortex could be shown as schemes for analysis and surgical plan. With the instruction of neuronavigation and the schemes,the loci which was out of the funtional area would be removed and that involving would be thermocoagulated. Results Four clinical seizures were captured with three cortical electrodes and the cortical function of 52 areas were detected. Depending on the collected information, the operation was performed without postoperative complication. There was neither seizure nor permanent neurological deficit was shown after the surgery. Conclusions The technique of image fusion realized the visual combination of cortical electrodes and 3D brain model as a brain - computer interface. It demonstrates a preliminary topological trial for millimeter - scale human brain mapping in order to provide more accurate localization for surgery involving eloquent cortex, and would make the clinical topology of brain mapping to be true.

关 键 词：神经导航 影像融合 皮层电极 功能区 拓扑学 

分 类 号：R651[医药卫生—外科学]