磁源性影像及神经电生理在功能区胶质瘤手术中的联合应用  

Application of magnetic source imaging and electroneurophysiology in glioma surgery near eloquent areas

作　　者：徐华中[1] 胡新华[1] 雷霆[1] 杨坤[1] 张玉海[1] 吴婷[2] 刘翔[1] 赵鹏来[1] 邹元杰[1] 刘宏毅[1] 

机构地区：[1]南京医科大学附属脑科医院神经外科,210029 [2]南京医科大学附属脑科医院脑磁图室,210029

出　　处：《中华神经外科杂志》2012年第12期1239-1242,共4页Chinese Journal of Neurosurgery

基　　金：南京市医学科技发展项目（QYK11127）;南京医科大学科技发展基金面上项目（2011NJMU098）;江苏省临床医学科技专项基金（BL2012041）

摘　　要：目的探讨磁源性影像（MSI）及其与神经电生理在功能区胶质瘤手术中联合应用的意义。方法23例涉及功能区胶质瘤患者，行MSI定位运动、感觉及语言区，并结合神经导航行显微手术切除病灶。其中6例与运动区关系密切者术中利用体感诱发电位波形倒置定位中央沟，行皮层电刺激定位运动区及皮层下电刺激定位锥体束。结果12例全切除，8例次全切除，3例大部切除。术后6例出现一过性神经功能障碍加重，仅1例出现长期神经功能损害，余16例未出现神经功能障碍。距离（MSI—Tumor）与术后功能障碍（一过性／长期）有相关性（P=0．001）。结论MSI可明确胶质瘤与功能区的位置关系，有助于对手术风险的评估并指导选择合理的手术方案；对与功能区关系密切者术中联合应用神经电生理监测，可对功能区进行精确定位并指导手术切除程度。Objective . To investigate the value of applying magnetic source imaging （MSI） and electroneurophysiology in glioma surgery near eloquent areas. Methods 23 patients with gliomas near eloquent areas underwent MSI to localize sensorimotor and speech cortex, and had resection of the lesions combining with neuronavigation. 6 patients had localization of central sulcus with SEP - PR, and had corti - subcortical electrical stimulation to preserve motor area and pyramidal tract. Results Total resection was achieved in 12 patients, subtotal in 8, and partial in 3. 6 patients had transient postoperative neurological disorders. Only one case suffered from permanent deficits. The distance （MSI -Tumor） was associated with postoperative neurological disorders（transient or permanent） （ P = 0. 001 ）. Conclusions MSI could provide the relationship between glioma and eloquent areas. It is helpful for the risk evaluation of glioma surgery and surgical plans. When the glioma is closely correlated with eloquent areas, accurate localization of eloquent areas combined with intraoperative electroneurophysiology could be achieved to guide the extent of resection.

关 键 词：脑磁图 功能定位 电刺激 体感诱发电位 磁源性影像 神经胶质瘤 

分 类 号：R739.4[医药卫生—肿瘤]