摘要
目的探讨高场强术中磁共振（iMRI）和功能神经导航联合术中神经电生理监测技术（IONM）指导手运动区病灶切除的方法和应用价值。方法天津医科大学总医院神经外科自2011年1月至2012年4月手术治疗16例手运动区附近病灶的患者，术中实时导航病灶、皮质脊髓束（CST）与手运动激活区，联合IONM进一步界定手运动区和病灶周围致痫灶，并通过iMRI及时更新影像，评估病灶切除程度。结果5例因为术中脑移位出现导航偏移，经iMRI更新后纠正，最终病灶全切13例，次全切3例。术后随访3—12个月，手运动功能好转10例，无变化6例，无手运动功能缺损病例。9例合并继发性癫痫患者，术后症状改善为EngelⅡ级及以上。结论术中磁共振成像技术、功能神经导航技术和神经电生理监测技术的联合应用，能优势互补，使得定位病灶与手运动区更加精准客观，在有效保留神经功能的同时最大限度地切除病灶。
Objective To explore the methods and applications of intraoperative magnetic resonance imaging （iMRI）-guided functional neuronavigation plus intraoperative neurophysiological monitoring （IONM） for microsurgical resection of lesions involving hand motor area. Methods A total of 16 patients with brain lesions adjacent to hand motor area were recruited from January 2011 to April 2012. All of them underwent neuronavigator-assisted microsurgery. Also IONM was conducted to further map hand motor area and epileptogenic focus. High-field iMRI was employed to update the anatomical and functional imaging date and verify the extent of lesion resection. Results Brain shifting during the functional neuronavigation was corrected by iMRI in 5 patients. Finally, total lesion resection was achieved in 13 cases and subtotal resection in 3 cases. At Months 3 - 12 post-operation, hand motor function improved （n = 10） or remained unchanged （ n = 6）. None of them had persistent neurological deficit. The postoperative seizure improvement achieved Enge I1 level or above in 9 cases of brain lesions complicated with secondary epilepsy. Conclusion Intraoperative MRI, functional neuronavigation and neurophysiological monitoring technique are complementary in microsurgery of brain lesions involving hand motor area. Combined use of these techniques can obtain precise location of lesions and hand motor functional structures and allow a maximum resection of lesion and minimization of postoperative neurological deficits.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第3期212-214,共3页
National Medical Journal of China
基金
天津市科委科学基金（12JCYBJC16900）
关键词
神经导航
术中磁共振
术中神经监测
脑
Neuronavigation
Intraoperative magnetic resonance imaging
Intraoperative neuromonitoring
Brain
