术前经颅磁刺激在语言功能区胶质瘤定位中的作用  

Effect of preoperative transcranial magnetic stimulation on language-eloquent glioma mapping

作　　者：路洪禄 冀晨辰 陈进 袁云超 武秀权 陈红庆 陆珍 张美霞 饶阳 费舟 李三中 赵静 LU Honglu;JI Chenchen;CHEN Jin;YUAN Yunchao;WU Xiuquan;CHEN Hongqing;LU Zhen;ZHANG Meixia;RAO Yang;FEI Zhou;LI Sanzhong;ZHAO Jing(Department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Department of Neurosurgery,Xijing 986 Hospital,Xi'an 710054,China;Department of Nursing,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Shaanxi Brain Modulation and Scientific Research Center,Xi'an 710075,China;Xi'an Solide Brain Control Medical Technology Co.,Ltd.,Xi'an 710086,China;Department of Anesthesiology,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院神经外科,陕西西安710032 [2]空军第九八六医院神经外科,陕西西安710054 [3]空军军医大学西京医院护理部,陕西西安710032 [4]陕西脑控脑科学研究中心,陕西西安710075 [5]西安索立德脑控医疗科技有限公司,陕西西安710086 [6]空军军医大学西京医院麻醉科,陕西西安710032

出　　处：《空军军医大学学报》2024年第12期1427-1431,共5页Journal of Air Force Medical University

基　　金：陕西省重点研发计划项目(2023-ZDLSF-17);陕西省技术创新引导计划建设项目(2024QCY-KXJ-035);空军军医大学西京医院学科助推计划项目(XJZT19ML13)。

摘　　要：目的验证经颅磁刺激(TMS)在术前定位中相对于术中直接电刺激(DES)的可靠性。方法纳入20例语言流利的胶质瘤患者,其中10例在术前进行了导航TMS(nTMS)标测(nTMS组),其余10例为非nTMS组(DES组)。nTMS组在术前语言任务时进行TMS检查。在连续3次试验中,记录该语言任务被干扰的靶点位置,定义为nTMS热点(HS_(nTMS))。两组患者均进行清醒手术和术中语言任务DES标测,并定义DES热点(HS_(DES))。nTMS组中HS_(nTMS)和HS_(DES)的空间分布被记录下来,并在一个单一的大脑模板中配准进行比较。采用基于HS_(nTMS)的重心(CoG)和基于HS_(DES)的CoG的弥散张量成像-纤维束追踪技术。进行电磁仿真,然后比较了nTMS组和DES组之间的值。结果HS_(nTMS)和HS_(DES)的分布相似[平均距离为(6.32±2.60)mm,距离范围为2.20~9.30 mm,95%CI:3.9~8.7]。在nTMS定位(P=0.0373)中观察到较高的分数各向异性分数值和类似的纤维束长度(P=0.2290)。nTMS和DES诱导的脑组织内的电场分布相似。结论术前TMS提供了对DES同样重要的数据,从而有助于精准地定位大脑功能。Objective To verify the reliability of transcranial magnetic stimulation(TMS)in preoperative mapping relative to intraoperative direct electrical stimulation(DES).Methods Twenty language-eloquent glioma patients were enrolled.Ten of them underwent preoperative navigated TMS(nTMS)mapping(nTMS group),and the other ten were assigned to DES group.Before surgery,TMS was performed during a language task in the nTMS group.Sites in the cortex at which this task was disturbed in three consecutive trials were recorded and defined as nTMS hotspots(HS_(nTMS)).Both groups then underwent awake surgery and intraoperative language mapping with DES.DES hotspots(HS_(DES))were also determined.The spatial distribution of HS_(nTMS)and HS DES in the nTMS group was recorded and registered in a single brain template for comparison.The center of gravity(CoG)based on HS_(nTMS)and diffusion tensor imaging fiber tracking of CoG based on HS DES were performed.The electromagnetic simulation was conducted,and then the values between nTMS group and DES group were compared.Results HS nTMS and HS DES showed similar distributions[mean distance:(6.32±2.60)mm,distance range:2.209.30 mm,95%CI:3.98.7].A higher fractional anisotropy value(P=0.0373)and an analogous fiber bundle length(P=0.2290)were observed in nTMS mapping.A similar distribution of the electric field in brain tissues induced by nTMS and DES was noted.Conclusion Preoperative TMS provides data equally crucial to DES and thus facilitates precise brain mapping.

关 键 词：经颅磁刺激 语言定位 纤维束追踪 电磁仿真 直接电刺激 

分 类 号：R739.41[医药卫生—肿瘤]