导致大脑皮质功能重构的胶质瘤手术治疗研究  

Surgical management of gliomas near eloquent area that induced cerebral functional plasticity

作　　者：刘翔宇 杭春华 张顶顶 李劲松 LIU Xiang-yu;HANG Chun-hua;ZHANG Ding-ding;LI Jin-song(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《临床神经外科杂志》2020年第5期533-537,542,共6页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(81771291);南京大学医学院附属鼓楼医院新技术项目(XJSFZJJ201926)。

摘　　要：目的围绕神经功能重塑理念,探讨切除引起脑功能区重构的胶质瘤的手术技术及其临床意义。方法回顾分析2017年10月—2020年2月手术治疗的9例脑功能区胶质瘤患者的临床资料。患者手术皆联合应用术中唤醒、直接电刺激定位和超声技术;术后均随访3个月以上。结果本组9例患者术中皆唤醒顺利,并定位出功能区(4例语言区,5例运动区)。术中发现患者运动区和语言区均发生重构,与正常解剖位置差异显著。在电生理皮质功能定位技术辅助下,肿瘤全切者8例,次全切除者1例。术后1例患者出现短暂性左下肢瘫痪,1例患者出现短暂语言障碍;无手术相关的永久性神经功能障碍者,无手术死亡病例。患者术后均无痛苦回忆。结论围绕功能重塑相关的解剖和病理生理机制,对功能区胶质瘤患者,术前完善相关影像检查及导航,术中联合唤醒技术、术中直接电刺激和脑超声技术,可明确脑功能区与肿瘤的关系,做到最大限度地切除脑功能区肿瘤,以及最大限度地保护神经功能,改善患者术后生活质量。Objective To explore the surgical technique and clinical significance of glioms that cause remodeling of brain functional areas.Methods The clinical data of 9 patients with gliomas in eloquent cortex from October 2017 to February 2020 were analyzed retrospectively.All the operations were combined with intraoperative awakening,intraoperative direct electrical stimulation and intraoperative brain ultrasonography.All patients were followed up for at least 3 months.Results All the 9 patients were awakened smoothly during the operation and the functional area was located(4 language areas,5 motor areas).During the operation,the reconstructed eloquent areas of the patients were found to be significantly different from the normal anatomical position.Of 9 patients,8 underwent total tumor resection and 1 underwent subtotal resection with the aid of electrophysiological cortical function localization technique.Transient one-sided limb movement disorder occurred in 1 patient after operation.Short-term language disorder occurred in 1 case.Operation related permanent neurological dysfunction was not observed.No patients died due to operation,and all patients had no painful memories after surgery.Conclusions Focusing on the anatomical and pathophysiological mechanisms related to functional remodeling,for patients with gliomas in functional areas,the relevant imaging examination and navigation should be improved before operation.Intraoperative wake-up technology,intraoperative direct electrical stimulation and intraoperative brain ultrasound technology can clarify the relationship between brain functional areas and tumors,so as to maximize the resection of brain functional area tumors and maximize the protection of neurological function,so as to ensure the quality of life after surgery.

关 键 词：胶质瘤 功能重塑 唤醒麻醉 直接电刺激 术中超声 

分 类 号：R739.41[医药卫生—肿瘤]