神经导航多模态融合在大脑运动区肿瘤手术中的应用  

Application of neuronavigation multimodal fusing combining intraoperative electrophysiological techniques in the tumor surgery of brain motor areas

作　　者：余龙洋 陈玉坤[2] 汪剑[2] 李亚楠[1] 岳志健[1] 

机构地区：[1]第二军医大学长海医院神经外科,上海200433 [2]第二军医大学长海医院影像科,上海200433

出　　处：《中华神经外科杂志》2016年第5期443-447,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨神经导航多模态融合技术结合术中神经电生理监测在大脑运动区肿瘤手术中的临床应用价值。方法回顾性分析第二军医大学长海医院神经外科2014年10月至2015年1月收治的20例病变位于大脑运动区附近的右利手患者，术前行磁共振弥散张量成像（DTI）和血氧水平依赖-功能磁共振（BOLD-fMRI）检查，获得白质纤维束原始资料和BOLD资料，经神经导航多模态融合DTI、BOLD和解剖像[必要时行大脑磁共振静脉成像（MRV）]并行三维重建，术中在导航辅助下行显微外科手术，并在神经电生理监测下确定中央前回、中央沟、中央后回及皮质下传导束。结果20例运动区肿瘤中，17例病变全切除，3例次全切除。术中的神经电生理监测结果与术前DTI和BOLD所重建的结果均相吻合。术后病理结果：神经胶质瘤9例（低级别4例，高级别5例），脑膜瘤11例。术后肌力无变化15例，出现一过性偏瘫5例，术后24h复查DTI均未见神经传导束明显受损，随访2周至3个月后患者能够生活自理。结论神经多模态融合技术可以准确定位运动功能区，并结合神经电生理监测弥补神经导航脑漂移所产生的误差，术中实时保护周边邻近传导束和功能区，减少术后神经功能障碍，在安全范围内最大程度地切除肿瘤。且术中神经电生理监测和术后早期DTI检查可以预测术后肌力情况，提高患者术后的生存质量。Objective To investigate the clinical application value of neuronavigation muhimodal fusing （ DTI and BOLD） combining intraoperative electrophysiological monitoring techniques in tumor surgery of brain motor areas. Methods From October 2014 to January 2015, 20 right-handed patients whose lesions were located near the brain motor areas admitted to the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were analyzed retrospectively. The patients received preoperative magnetic resonance diffusion tensor imaging （DTI） and blood oxygen level dependent-functional magnetic resonance imaging （BOLD-fMRI） examinations. The original data of white matter fiber tracts and BOLD data were obtained. The neural navigation multimodal fusion DTI, BOLD, anatomical images [ brain magnetic resonance venography （ MRV ） , if necessary ] , and the three-dimensional reconstruction were performed. The microsurgery was performed under the assisted navigation during the operation, and the anterior central gyrus, central sulcus, posterior central gyrus, and subcortical tracts were determined under the neural electrophysiological monitoring. Results Of the 20 patients with motor area tumor, the lesions of 17 patients were resected, and 3 were resected subtotally. The intraoperative electrophysiological results were consistent with the preoperative DTI and BOLD reconstructed results. Postoperative pathological results： 9 patients had glioma （low-level 4 and high-level 5 ） and 11 had meningioma. The postoperative muscle strength of 15 patients did not have any change, 5 had transient hemiparesis. DTI showed that there was no obvious damage to the nerve tracts at 24 h after procedure. After being followed up for 2 weeks to 3 months, the patients were able to take care of themselves. Conclusions Neuronavigation multimodal fusing can accurately locate the motor function areas, and combined electrophysiological monitoring can compensate for the errors caused by the drift of the neural navigati

关 键 词：神经导航 弥散张量成像 功能磁共振成像 电生理学 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤]