视辐射重建对前颞叶切除术视野的保护研究  

Protective effect of optic radiation reconstruction against the risk of visual field deficits in anterior temporal lobectomy

作　　者：崔志强[1] 凌至培[1] 潘隆盛[1] 陈晓雷[1] 王群[1] 张治中[1] 齐叶青[1] 徐欣[1] 毛之奇[1] 王伟君[1] 孙璐[1] 余新光[1] 栾国明[2] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]首都医科大学三博脑科医院神经外科癫痫病临床医学研究北京市重点实验室,北京100093

出　　处：《中国现代神经疾病杂志》2015年第9期707-711,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：首都医科大学省部级重点实验室开放研究课题(项目编号:2013DXBL01)~~

摘　　要：目的探讨扩散张量纤维束示踪成像（DTT）技术重建视辐射与术中MRI（i MRI）和显微镜下导航在前颞叶切除术中对视野的保护作用。方法采用前颞叶切除术治疗24例难治性颞叶癫患者,术前采用DTT技术重建视辐射,术中同时行i MRI和显微镜下导航,根据视辐射前缘（Meyer环）至颞极距离切除前颞叶,术后3个月复查静态视野和Engel分级评价癫发作控制情况。结果本组患者均成功重建视辐射,均行i MRI扫描,无一例发生术区和远隔部位出血。手术切除颞叶1.90～5.10 cm,平均3.29 cm。术后随访3～21个月,平均11.33个月。术后3个月复查静态视野,16例（66.67%）无视野缺损、8例（33.33%）有轻度视野缺损（〈1/4象限）,其中1例术前即有轻度视野缺损,术后无加重;Engel分级Ⅰ级19例（79.17%）、Ⅱ级4例（16.67%）、Ⅲ级1例（4.17%）。结论对于诊断明确的药物难治性颞叶癫患者,DTT技术重建视辐射联合i MRI和显微镜下导航,于视辐射前缘切除颞叶,可以减少视辐射损伤,减轻视野缺损。Objective To explore the clinical value of optic radiation reconstruction in protecting against visual field deficits （VFDs） in anterior temporal lobectomy （ATL）. Methods We retrospectively analyzed 24 patients with medically refractory temporal lobe epilepsy undergoing ATL between January 2013 and June 2014. The surgical operations were aided by combining optic radiation reconstruction by diffusion tensor tractography （DTT）, microscopy- based neuronavigation and intraoperative MRI （iMRI） techniques. ATL was performed according to the distance between Meyer＇s loop and temporal pole. The visual fields were examined and seizure outcomes were evaluated by Engel class test in 3-month follow-up. Results The optic radiation was reconstructed in all patients. No bleeding was found in operative site or distant site by iMRI scan. The size of removed temporal lobe was 3.29 cm （1.90-5.10 era）. Visual field testing 3 months after operation showed no VFDs in 16 cases （66.67%） and mild VFDs （〈 1/4 quadrant） in 8 cases （33.33%）, One case suffered mild VFD before operation, but did not aggravate after operation. Engel class test showed Engel class I in 19 patients （79.17%）, class Ⅱ in 4 patients （16.67%） and class m in one patient （4.17%）. Conclusions For patients with medically refractory temporal lobe epilepsy, the techniques of combining optic radiation reconstruction, microscopy-based neuronavigation and iMRI aidedin precise mapping could reduce the risk of visual field deficits in anterior temporal lobectomy.

关 键 词：前颞叶切除术 视神经 视野 磁共振成像 弥散 神经导航 

分 类 号：R651.1[医药卫生—外科学]