[1]张玉海,刘宏毅,张锐,等.多模态影像联合电生理监测在脑功能区胶质瘤手术中的应用研究[J].临床神经外科杂志,2016,(05):335-339.
 ZHANG Yu-hai,LIU Hong-yi,ZHANG Rui,et al.Application of multimodal neurological imaging and neurophysiological monitoring in surgical resection for eloquently located cerebral gliomas[J].Journal of Clinical Neurosurgery,2016,(05):335-339.
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多模态影像联合电生理监测在脑功能区胶质瘤手术中的应用研究()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2016年05期
页码:
335-339
栏目:
胶质瘤专题
出版日期:
2016-10-07

文章信息/Info

Title:
Application of multimodal neurological imaging and neurophysiological monitoring in surgical resection for eloquently located cerebral gliomas
作者:
张玉海刘宏毅张锐胡新华杨坤刘永何升学钱春发邹元杰章文斌陈永严杨纶先黄庆玖刘翔陆军阮义峰
210029 南京医科大学附属脑科医院神经外科(张玉海,刘宏毅,胡新华,杨坤,刘永,何升学,钱春发,邹元杰,章文斌,陈永严,杨纶先,黄庆玖,刘翔),癫痫中心(张锐),麻醉科(陆军,阮义峰)
Author(s):
ZHANG Yu-hai LIU Hong-yi ZHANG Rui et al.
Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
关键词:
多模态影像功能区电生理监测功能磁共振弥散张量成像胶质瘤
Keywords:
multimodal imaging eloquent area neurophysiological monitoring functional MRI diffusion tensor image glioma
分类号:
R739.41
文献标志码:
A
摘要:
目的:研究多模态影检查联合电生理监测技术在脑功能区胶质瘤手术中的保护脑功能的应用价值。 方法:回顾性分析5例语言区和55例运动区胶质瘤患者的临床资料。术前行功能磁共振定位功能区,弥散张量成像显示重要传导束,融合多模态影像构建功能神经导航,术中采用皮层体感诱发电位定位中央沟,并运用皮层-皮层下电刺激技术监测语言区、运动区和皮层下重要神经传导束,在保护功能前提下尽可能切除病灶。术后评价肿瘤切除程度和神经功能。 结果:5例语言区胶质瘤和30例病变毗邻运动皮层胶质瘤患者术前功能磁共振成功定位功能区,通过弥散张量成像3例语言区胶质瘤和42例胶质瘤患者分别重建出弓状束和锥体束。术中电刺激语言区和运动区检出率分比为100%和92.7%;92.7%的运动区肿瘤患者可通过皮层体感诱发电位技术定位中央沟。术中神经导航对手术具有指导作用。肿瘤影像全切率86.7%,术后功能保留率91.7%。 结论:运用多模态影像技术有助于术前定位脑功能区,功能神经导航有助于术前规划、术中引导病灶切除,但需注意影像漂移。术中电生理监测技术是定位和保护脑功能结构的主要手段。
Abstract:
Object:To explore the role of multimodal neurological imaging and intraoperative neurophy-siological monitoring(IOM) in eloquent area glioma surgery.Methods:The clinical data of 5 patients with language area glioma and 55 with sensorimotor area glioma were analyzed retrospectively.Functional MRI (fMRI), diffusion tensor image (DTI) were performed preoperatively and were immerged into neuronavigation system for preoperative planning and intraoperative real-time guiding for the procedure. In cases with perirolandic tumors, cortical somatosensory evoked potential (SEP) was recorded to locate the central sulcus. Tumor resection was alternated with direct electrical stimulation (DES) and functional structures were preserved during the operation. Extent of tumor resection and neurological status were evaluated postoperatively.Results:Functional areas were localized by fMRI in 5 language area glioma cases and 30 sensorimotor area glioma cases. By diffusion tensor fiber tractography(DT-FT), arcuate fasciculus was traced in 3 cases with language area glioma, and motor pathways were traced in 42 cases with deeply-seated motor eloquent area glioma. Intraoperatively, language area and motor area were located by DES in 100% language area glioma cases and 92.7% motor area glioma cases respectively. Central sulcus could be located in 92.7% motor area cases using cortical SEP recording.

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备注/Memo

备注/Memo:
南京市医学科技发展项目(课题)(YKK13123)
更新日期/Last Update: 2016-10-15