术中磁共振皮质脊髓束重建联合显微镜下导航在中央区癫痫外科治疗中的应用  

Clinical study of resection of the epileptic foci involving sensorimotor cortex by microscopic-based neuro-navigation and the reconstruction of pyramidal tract using intraoperative magnetic resonance imaging

作　　者：崔志强[1] 凌至培[1] 许百男[1] 胡深[1] 李晔[1] 陈晓雷[1] 孙国臣[1] 潘隆盛[1] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853

出　　处：《立体定向和功能性神经外科杂志》2013年第1期5-9,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨术中磁共振皮质脊髓束重建联合显微镜下导航在治疗功能区癫痫中的价值。方法回顾性分析2009年1月至2011年6月涉及运动感觉皮层的癫痫患者23例。所有患者均放置颅内电极,术前弥散张量纤维束示踪技术重建锥体束。在导航下切除病灶及癫痫灶,术中常规磁共振扫描,根据病灶、癫痫灶切除程度实时更新导航数据。术后分别于住院期间及术后6个月记录肢体肌力变化,根据Engel癫痫术后评分,评定术后疗效,分析所得数据。结果所有患者均成功重建了皮质脊髓束。术后住院期间有10例(43.48%)出现了肢体肌力下降,6个月后随访,3例(13.04%)肌力未回复到术前水平。术后随访18～42个月(平均28.22±7.48个月),术后癫痫控制总有效率为87.0%。Engel评分Ⅰ级8例(34.8%);Ⅱ级5例(21.7%);Ⅲ级7例(30.4%);Ⅳ级3例(13.0%)。结论应用磁共振弥散张量纤维束示踪技术重建锥体束及显微镜下导航技术,在术中可精确定位病灶、癫痫灶,实时指导术者实施手术,可显著提高手术疗效,减少术后功能缺失。Objective To explore the clinical value of reconstruction of pyramidal tract, microscopic--based neuro--navigation and intraoperative magnetic resonance imaging （iMRI） in the surgical treatment of the epileptic loci involving sensorimotor cortex. Methods We retro- spectively analyzed 23 patients with focal epilepsy involving motor and sensory cortex. The pa- tients were operated between January 2009 and June December 2011. All operations were per- formed with the assistance of reconstruction of pyramidal tract, microscopic--based neuro--navi- gation, and the iMRI. The iMRI was applied to evaluate whether further resection is required. Intracranial electrodes were implanted into 21 patients to locate the epileptic foci and for the func- tional mapping. Results The pyramidal tract of each patient was reconstructed successfully. Ten patients, 43.5 % of all patients, experienced the deterioration of limb muscle strength during the hospitalization. After the 18 months follow-up, 3 patients （13.0%） did not recover to the pre operative levels. The follow-up after 28.2 months of the surgical intervention, the Engel class I outcome was achieved in 8 patients （34. 8%）, class II was achieved in 5 patients （21.7%）, class III was achieved in 7 patients （30.4%）, and class IV was achieved in 3 patients （13.0%）. Con- clusion The technique of reconstruction of pyramidal tract, microscopic-based neuro-naviga- tion and the iMRI assist a surgeon to perform precise resections of lesions and to locate the epilep-tic foci in sensorimotor cortex, to significantly improve the efficacy of the surgery, and to reduce the prevalence of the postoperative loss of function.

关 键 词：术中磁共振 显微镜下导航 弥散张量成像 皮质脊髓束重建 功能区癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]