功能神经导航引导下的直接电刺激术在功能区肿瘤手术神经功能保护中的应用  

Application of navigation-assisted direct electrical stimulation in protection of neurologic function in tumor surgery located at functional areas

作　　者：钟平[1] 姚一[1] 江建东[1] 张小斌[1] 高志莹 王逢鹏[1] 张卿云 高登科[1] 

机构地区：[1]解放军第一七四医院(厦门大学附属成功医院)神经医学中心,厦门361003

出　　处：《中华神经医学杂志》2015年第9期879-884,共6页Chinese Journal of Neuromedicine

基　　金：南京军区医学科技创新项目（ZD26）

摘　　要：目的探讨功能神经导航引导下的直接电刺激术（DES）在功能区肿瘤手术神经功能保护中的应用。方法厦门大学附属成功医院神经医学中心自2012年12月至2014年月10月在功能区肿瘤切除术中将双极刺激电极连接神经导航系统，在功能神经导航引导下行DES识别定位功能区并指导切除肿瘤10例，回顾性分析患者的疗效、手术前后语言和运动功能的变化。结果10例肿瘤中全切7例，次全切3例；术中准确识别定位8例（80％）患者的相关功能区，其中识别皮质运动功能区4例，皮质下运动传导束6例，定位皮质下语言传导束1例；术后3例患者出现运动功能轻度下降，经康复锻炼后1例恢复至术前水平。无致残性运动功能障碍发生：术前存在语言功能障碍的4例患者术后仅1例出现语言功能轻度下降，另外3例获得一定程度的改善，其余患者术后语言功能均无影响。结论功能神经导航引导下的DES可显著降低功能区肿瘤手术后神经功能障碍的发生率，改善患者生活质量。Objective To explore the application of navigation-assisted direct electrical stimulation （DES） in the protection of neurologic function in surgery of tumors located at functional areas. Methods Ten patients with brain tumors at the functional areas, admitted to our hospital from December 2012 to October 2014, were chosen; they were performed navigation-assisted DES using bipolar stimulating electrodes connected neuronavigation system. Preoperative motor function evaluated by Fugl-Meyer scale and verbal function evaluated by Western Aphasia Battery were underway. The motor and language functions and tumor resection rate were analyzed and compared before and after surgery. Results Total resection was achieved in 7 patients and subtotal resection in 3 patients. Accurate identification of related ftmctional areas was successful in 8 patients （80%） in the operation, including 4 of the cortical motor function area, 6 of subcortical motor tracts, and one of subcortical language conduction bundle. After the operation, one patient experienced transient motor dysfunction and recovered after 3 months, and two experienced mild decline in motor function （20%）, but there was no dysfunction of disabling movement. In four patients with language dysfunction, one experienced language function decline （10%） and 3 got improvement （30%）. The postoperative neurologic protection was satisfied. Conclusion Navigation-assisted DES can significantly reduce the occurrence rate of postoperative neurological dysfunction, improve the life quality of patients with tumors located at the functional areas.

关 键 词：神经导航 弥散张量成像 直接电刺激术 功能区 神经功能 

分 类 号：R739.41[医药卫生—肿瘤]