术中唤醒结合神经导航在脑功能区胶质瘤手术中的应用价值分析  

Intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas

作　　者：苏海波[1] 张玲琼 陈保东 张淼[1] 史瑞萍 吴涛[1] Su Haibo;Zhang Lingqiong;Chen Baodong;Zhang Miao;Shi Ruiping;Wu Tao(Department of Neurosurgery,Shenzhen Hospital of Peking University,Shenzhen 518036,China;Dapertment of Hand Microsurgery,Shenzhen Hospital of Peking University,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院神经外科,深圳518036 [2]北京大学深圳医院手显微外科,深圳518036

出　　处：《中华神经医学杂志》2020年第6期546-551,共6页Chinese Journal of Neuromedicine

基　　金：深圳市卫生计生系统科研项目(SZXJ2018082、SZXJ2017010);深圳市三名工程项目(SZSM201612008)。

摘　　要：目的探讨术中唤醒结合神经导航在脑功能区胶质瘤切除术中的应用价值。方法选择北京大学深圳医院神经外科自2017年10月至2019年6月收治的脑功能区胶质瘤患者20例,术前均使用血氧水平依赖功能磁共振成像(BOLD-fMRI)显示功能区皮层,同时采用弥散张量成像(DTI)技术重建肿瘤周边纤维束,将上述图像融合后,导入神经导航系统,术中显微镜下确定功能区皮层与纤维束,同时应用术中唤醒联合皮层电刺激定位再次确定功能区后切除肿瘤。比较患者术前、术后2周、术后3个月Karnofsky功能状态评分(KPS)的变化,记录手术相关并发症和死亡情况。结果20例患者均在神经导航和术中唤醒联合皮层电刺激下成功实施手术,最终16例(80%)胶质瘤全切除,4例(20%)次全切除。术后2周、术后3个月随访显示仅1例高级别胶质瘤患者的KPS评分较术前降低,无术后死亡及严重致残病例。与术前KPS评分(83.02±4.76)比较,患者术后2周的KPS评分(90.15±6.72)、术后3个月KPS评分(96.86±6.18)均明显增加,差异均有统计学意义(P<0.05)。结论术中唤醒联合皮层电刺激结合神经导航能准确地定位功能区皮层及纤维束,准确评估胶质瘤切除范围,可以在最大程度切除病变的同时保护患者的神经功能。Objective To explore the application value of intraoperative awake combined with neuronavigation in surgery for eloquent area gliomas.Methods Twenty patients with eloquent area gliomas,admitted to our hospital from October 2017 to June 2019,were chosen in our study.Preoperative blood oxygenation level dependent-functional MR imaging(BOLT-fMRI)was used to display the functional cortex in all patients,and diffusion tensor imaging(DTI)was used to reconstruct the peripheral fibrous tracts of the gliomas;after imaging fusion of above function structures,the data were imported into the neuronavigation system;intraoperative microscope was used to determine the functional areas in the cortex and the fiber bundle,and intraoperative awake combined with cortical stimulus was employed to determine the functional areas in the cortex again before removal of the tumors.Changes in patients'quality of life(Karnofsky performance scale,[KPS]scores)before surgery,2 weeks after surgery,and 3 months after surgery were compared,and surgical-related complications or death were recorded.Results Intraoperative awake combined with neuronavigation were successfully applied with the addition of cortical electrical stimulation in all 20 patients;16(80%)accepted total resection and 4(20%)accepted subtotal resection.Follow-up for 2 weeks after surgery and 3 months after surgery showed that only one patient with high-grade glioma had decreased KPS scores than those before surgery,and there were no postoperative deaths or severe disabilities.As compared with KPS scores before surgery(83.02±4.76),those at 2 weeks after surgery(90.15±6.72)and 3 months after surgery(96.86±6.18)were significantly higher(P<0.05).Conclusion Intraoperative awake combined with neuronavigation can locate the eloquent area and fibers accurately,help neurosurgeons to resect gliomas totally in the surgery and protect patients'neuro-function.

关 键 词：神经胶质瘤 功能区 神经导航 术中唤醒 皮层电刺激 

分 类 号：R739.41[医药卫生—肿瘤]