术中磁共振导航技术在脑功能区周围动-静脉畸形切除术中的应用  

Clinical application of intraoperative MRI navigation in microsurgical resection of cerebral arteriovenous malformations located near the main functional areas

作　　者：孔东生 孙正辉[1] 武琛[1] 姜金利[1] 薛哲[1] 马玉栋[1] 王文鑫[1] 程林[1] 张治中[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中国现代神经疾病杂志》2016年第12期839-844,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京市科技计划项目(项目编号:Z141107002514052)~~

摘　　要：目的 探讨术中MRI导航下显微外科手术切除位于脑功能区周围动-静脉畸形的有效性和安全性。方法 对53例脑功能区周围动-静脉畸形患者行术中MRI导航联合术中电生理学监测下显微外科手术,同时于术前和术中行血氧水平依赖性功能磁共振成像（BOLD-f MRI）和扩散张量成像（DTI）,将BOLD-f MRI与DTI图像融合,形成病变、脑功能区和锥体束的三维图像,观察手术前后三者的关系和变化。结果 53例脑功能区周围动-静脉畸形患者,畸形团直径2~7 cm、平均（3.41±0.85）cm,病变毗邻感觉功能区6例、运动功能区7例、锥体束10例、语言功能区14例、视觉皮质2例、视辐射9例、基底节2例、脑干3例。49例在保留重要功能前提下全切除畸形团,4例因术中MRI导航确定畸形团与脑功能区关系密切而残留部分畸形团。术后8例新发神经功能障碍,其中双侧视野缺损1例、肌张力降低3例、面瘫1例、失语2例、肌张力降低合并运动性失语1例。术后随访3~60个月,中位时间[19.37（6.00,30.00）]个月,Glasgow预后分级5分45例（84.91%）、4分3例（5.66%）、3分2例（3.77%）、2分1例（1.89%）、1分2例（3.77%）,其中1例于术后1年死于呼吸衰竭,1例死因不明。结论 采用术中MRI导航联合电生理学监测技术可以适当扩大位于脑功能区周围动-静脉畸形的手术适应证。Objective To evaluate the efficacy and safety of intraoperative MRI navigation in the microsurgical treatment of arteriovenous malformations （AVM） located near the main functional areas of brain. Methods A total of 53 patients with AVM in the adjacent functional areas were treated by microsurgical operation with intraoperative MRI navigation and electrophysiological monitoring. Blood oxygenation level-dependent functional magnetic resonance imaging （BOLD-fMRI） and diffusion tensor imaging （DTI） examinations were performed before and during operation. We fused BOLD-fMRI and DTI images to form three-dimensional images containing lesions, important functional areas and pyramidal tract so as to study the relationship between them and their changes before and after operation. Results The diameter of malformations in 53 patients was 2-7 cm, on average of （3.41 ＋ 0.85） cm. There were 6 patients involved in sensory areas, 7 patients in motor areas, 10 patients in pyramidal tract, 14 patients in language areas, 2 patients in visual cortex, 9 patients in optic radiation, 2 patients in basal ganglia and 3 patients in brain stem. Gross total resection was achieved in 49 patients while full functionality was retained. The other 4 patients＇with intraoperative MRI navigation were found that malformations and functional areas were closely related, so the lesions were partially resected. There were 8 patients with new-onset postoperative neurological dysfunction, among whom one case was found bilateral visual field defects, 3 patients＇ muscle tone was lower than before, one case of facial paralysis, 2 cases of aphasia, one with decreased muscle tone and motor aphasia. Follow-up period varied from 3 to 60 months [median 19.37 （6.00, 30.00） months], and 2 eases died （one died of respiratory failure after one year, and the other was agnogenie）. Glasgow Outcome Scale （GOS） score was 5 in 45 eases （84.91%）, 4 in 3 eases （5.66%）, 3 in 2 eases （3.77%）, 2 in one ease （1.89%） and one in 2

关 键 词：颅内动静脉畸形 磁共振成像 显微外科手术 

分 类 号：R651.12[医药卫生—外科学]