脑磁图及弥散张量成像在中央区低级别胶质瘤手术中的应用  

Application of magnetoencephalography and diffusion tensor imaging in low-grade glioma surgery of central areas

作　　者：张建 林涛 李业海 

机构地区：[1]广东三九脑科医院神经外科,广州515515

出　　处：《中华神经外科杂志》2015年第7期676-680,共5页Chinese Journal of Neurosurgery

基　　金：广东省医学科学技术研究基金（A2012468）

摘　　要：目的探讨联合利用脑磁图（MEG）、弥散张量成像技术（DTI）和神经导航技术，在中央区低级别胶质瘤切除中神经功能保护的作用。方法对40例涉及中央区的Ⅱ级脑胶质瘤患者，随机分成对照组和试验组两组，每组20例。对照组按照常规神经导航定位肿瘤行手术切除；试验组将脑磁图、DTI与神经导航序列影像融合进行术中导航，术中可视下定位脑皮质功能区及皮质下传导束，来实现精确切除病灶。术后3d内行MRI、DTI检查，比较两组患者的肿瘤切除程度、神经传导束完整性及术后1个月神经功能恢复情况、KPS评分。结果试验组肿瘤全切除率85％（17／20）显著高于对照组55％（11／20）；试验组术后致瘫率25％（5／20）显著低于对照组60％（12／20）；试验组术后1个月平均KPS评分（84．50±21．6）分显著高于对照组（64．05±33．36）分。两组在肿瘤切除率、纤维束（FA值）、神经功能保存、KPS评分上的比较，差异均具有统计学意义（均P〈0．05）。结论通过联合利用MEG、DTI及神经导航技术，可最大限度地切除中央区胶质瘤，并更好地保留患者的神经功能，提高其生存质量。Objective To investigate the effect of neurological function protection of low-grade glioma resection of central areas in combination with magnetoencephalography （ MEG ） , diffusion tensor imaging （DTI） , and neuronavigation technology. Methods Forty patients with glioma grade ]1 involving central areas were randomly divided into either a control group or an experimental group （ n = 20 in each group）. According to the conventional nerve navigation, the gliomas were localized and resected surgically in the control group; the magnetoencephalography, DTI and neural navigation image sequence were fused for intraoperative navigation in the experimental group, and the cerebral cortical functional areas and subcortical tracts were located under the intraoperative visualization in order to achieve the precise excision of the lesions. Within 3 days after procedure, the patients conducted MRI and DTI examinations. The extent of glioma resection, the integrity of nerve tracts, the recovery of neurological function at 1 month after procedure, and the KPS scores in both groups were compared. Results The total resection rate of gliomas in the experimental group （85% , 17/20 ） was significantly higher than that of the control group （55% , 11/20）. The postoperative paralyzed rate in the experimental group （25% , 5/20） was significantly lower than that of the control group （60%, 12/20）. The mean Karnofsky performance scale （KPS） score （84. 50 ± 21.6 ） at one month after procedure in experimental group was significantly higher than that in the control group （64. 05± 33.36）. There were significant differences in glioma resection rate, fiber tracts （FA value） , neurological preservation, and KPS scores between the two groups （P 〈 0. 05 ）. Conclusion By the combined use of MEG, DTI, and neural navigation technology, the gliomas in central areas can be removed as much as possible and better preserve the neurological function of patients in order to improve their quality of life.

关 键 词：神经胶质瘤 运动皮质 躯体感觉皮质 脑磁图描记术 弥散张量成像 神经导航 神经功能保护 

分 类 号：R739.41[医药卫生—肿瘤]