功能神经导航和术中磁共振引导下精确切除毗邻大脑运动功能区的致病变  

Precise resection of epileptogenic foci near motor-related brain regions guided by functional neuronavigation combining with intraoperative magnetic resonance imaging

作　　者：刘智良[1] 徐如祥[1] 刘建明[1] 孟繁鑫[1] 游宇[1] 丁虎[1] 尹鹏[1] 白俊超[1] 葛光治[1] 刘卫[1] 满丽[1] 刘凤[1] 戴宜武[1] 

机构地区：[1]北京军区总医院附属八一脑科医院癫中心,100700

出　　处：《中国微侵袭神经外科杂志》2013年第8期354-357,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的评估功能神经导航和术中MRI引导对毗邻运动功能区致癎病变切除术的效果。方法回顾性分析接受神经导航引导手术的14例癫癎病人,其中10例采用术中MRI。术前MRI扫描,融合影像,设计病变切除范围及入路,三维计划输入导航系统并投射至手术显微镜辅助手术。术中复查MRI,对残余病变重新定位,实施手术切除。术后定期进行随访。结果病人均成功实施了功能神经导航,致癎病变、运动区皮质和锥体束投射在手术显微镜下,精确切除病变,同时运动区皮质和锥体束获得有效保护;术中MRI末次扫描提示致癎灶病变的切除范围达到术前计划。术后随访6~24个月,癫癎发作控制达EngelⅠ级12例,EngelⅡ级2例。未出现肢体肌力下降。结论对于毗邻运动功能区的致癎病变,通过功能神经导航和术中MRI精准定位病灶和功能区,可以达到精准切除病变并保护正常脑功能的目的。Objective To evaluate the clinical efficacy of functional neuronavigation and intra-operative magnetic resonance imaging（iMRI） in resection of epileptogenic foci near motor-related brain regions.Methods The clinical data of 14 epileptic patients with lesion adjacent to motor-related brain regions were analyzed retrospectively.All the patients underwent surgical operation assisted by functional neuronavigation and the iMRI was performed for 10 patients.Before the operation,MRI scanning,imaging fusion,design of lesion excision extent and surgical approach were performed successively.3D reconstructed navigation plan were integrated into neuronavigation system and used by combining with functional neuronavigation under microscope during the surgical procedure.During the operation,the operative plan of the residuary lesion was redesigned according to the iMRI.After the operation,the regular follow-up was performed.Results The functional neuronavigation was completed successfully.The lesions,motor area cortex and pyramidal tracts were projected into operating microscope.The lesions were precisely excised,and the motor cortex and pyramidal tracts were effectively protected.The last iMRI indicated that the range of resection was coincided with the pro-operative plan.During the follow-up from 6 to 24 months,according to Engel classification,seizure control was grand Ⅰin 12 patients and grand Ⅱ in 2.There was no decrease of limb muscle strength in all the patients.Conclusions Functional neuronavigation combined with iMRI is a safe and reliable technique for accurate resection of the lesion adjacent to motor-related brain regions and for protection of normal brain function by precise location of the lesion and important functional structures.

关 键 词：癫癎痫 运动功能区 神经导航 术中MRI 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]