术中唤醒结合磁共振神经导航系统在功能区脑部肿瘤手术中的应用价值  

Application value of intraoperative awakening combined with magnetic resonance neuronavigation system in brain tumor surgery in functional area

作　　者：高洪霞 陈小琴 GAO Hongxia;CHEN Xiaoqin(Anesthesiology Surgery Center,Sichuan People's Hospital of Sichuan Provincial Academy of Medical Sciences,Chengdu 610000;Department of Neurosurgery,Sichuan People's Hospital of Sichuan Provincial Academy of Medical Sciences,Chengdu 610000)

机构地区：[1]四川省医学科学院·四川省人民医院麻醉手术中心,成都610000 [2]四川省医学科学院·四川省人民医院神经外科,成都610000

出　　处：《磁共振成像》2021年第10期41-44,共4页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的研究术中唤醒结合磁共振神经导航系统在功能区脑部肿瘤手术中的应用价值。材料与方法选取2018年7月至2020年7月于我院神经外科就诊并接受功能区脑部肿瘤手术治疗的50例患者作为研究对象,按照随机数字表法将其分为对照组(25例)和观察组(25例)。50例患者术前均通过MRI行脑组织结构图像采集,尤其是通过弥散张量成像(diffusion tensor imaging,DTI)序列和血氧水平依赖功能MRI(blood oxygenation level dependent-functional magnetic resonance imaging,BOLD-fMRI)序列扫描显示功能区和重建皮质脊髓束;通过神经导航系统建立颅内结构、肿瘤结构和周围组织结构的三维影像模型。同时,观察组患者利用术中唤醒技术再次确定功能区后切除病变。观察两组患者的手术时间、肿瘤切除程度、神经功能卡氏评分(Karnofsky,KPS)和术后并发症发生率。结果观察组患者的手术时间和术后住院时间显著低于对照组(t=-2.232、-5.788,P=0.030、P<0.001);观察组患者的肿瘤切除程度显著高于对照组(Z=5.128,P=0.028);观察组患者术后6个月的KPS评分显著高于对照组(t=4.861,P<0.001),且术后并发症发生率显著低于对照组,差异均具有统计学意义(χ^(2)=5.094,P=0.024)。结论术中唤醒结合磁共振神经导航系统不仅可以提高脑部功能区肿瘤的最大切除程度,还能够保护脑部功能区的重要神经功能,可以在临床推广应用。Objective:To investigate the value of intraoperative wakefulness combined with MR neuronavigation system in the operation of functional brain tumors.Materials and Methods:A total of 50 patients admitted to the department of neurosurgery of our hospital from July 2018 to July 2020 who received surgical treatment for brain tumors in functional areas were selected as the research subjects.They were divided into a control group(25 cases)and an observation group(25 cases)according to the random number table.The observation group was treated with intraoperative awakening combined with magnetic resonance neuronavigation,while the control group was only subjected to magnetic resonance neuronavigation before surgery.All the 50 patients underwent preoperative brain tissue image acquisition by MRI,especially through the diffusion tensor imaging(DTI)sequence and blood oxygenation level dependent functional MRI(BOLD-fMRI)sequence scanning to display the functional areas and reconstruct the corticospinal tract.Three-dimensional imaging models of intracranial structure,tumor structure and surrounding tissue structure were established by using the neuronavigation system.At the same time,patients in the observation group were resected after redefining the functional area by intraoperative wake-up technique.The operative time,tumor resection degree,neurological function(Karnofsky)score and incidence of postoperative complications in 2 groups were observed.Results:The operation time and postoperative hospital stay of patients in the observation group were significantly lower than those in the control group(t=-2.232,-5.788,P=0.030,P<0.001).The tumor resection degree of patients in the observation group was significantly higher than that in the control group(Z=5.128,P=0.028);the KPS score of the observation group six months after surgery was significantly higher than that of the control group(t=4.861,P<0.001),and the incidence of postoperative complications was significantly lower than that of the control group.The differences were s

关 键 词：功能区脑部肿瘤 术中唤醒 磁共振神经导航系统 弥散张量成像 血氧水平依赖 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]