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目的探讨术中磁共振皮质脊髓束重建联合显微镜下导航在治疗功能区癫痫中的价值。方法回顾性分析2009年1月至2011年6月涉及运动感觉皮层的癫痫患者23例。所有患者均放置颅内电极,术前弥散张量纤维束示踪技术重建锥体束。在导航下切除病灶及癫痫灶,术中常规磁共振扫描,根据病灶、癫痫灶切除程度实时更新导航数据。术后分别于住院期间及术后6个月记录肢体肌力变化,根据Engel癫痫术后评分,评定术后疗效,分析所得数据。结果所有患者均成功重建了皮质脊髓束。术后住院期间有10例(43.48%)出现了肢体肌力下降,6个月后随访,3例(13.04%)肌力未回复到术前水平。术后随访18～42个月(平均28.22±7.48个月),术后癫痫控制总有效率为87.0%。Engel评分Ⅰ级8例(34.8%);Ⅱ级5例(21.7%);Ⅲ级7例(30.4%);Ⅳ级3例(13.0%)。结论应用磁共振弥散张量纤维束示踪技术重建锥体束及显微镜下导航技术,在术中可精确定位病灶、癫痫灶,实时指导术者实施手术,可显著提高手术疗效,减少术后功能缺失。
Objective To investigate the value of intraoperative magnetic resonance corticospinal tract reconstruction combined with microscopic navigation in the treatment of functional epilepsy. Methods A retrospective analysis of 23 patients with epilepsy involving motor sensory cortex from January 2009 to June 2011 was performed. All patients were placed intracranial electrodes, preoperative diffusion tensor tractography tracing technique to reconstruct the pyramidal tract. In the navigation under the removal of lesions and epileptic foci, intraoperative conventional magnetic resonance scan, according to the lesion, epileptic foci of real-time update navigation data. The changes of limb muscle strength were recorded during hospitalization and 6 months after surgery. The postoperative efficacy was evaluated according to the postoperative Engel’s score, and the data were analyzed. Results All patients successfully reconstructed corticospinal tract. Ten patients (43.48%) underwent postoperative hospital stay with decreased muscle strength. Follow-up was performed after 6 months. Three patients (13.04%) did not return to the preoperative level. The patients were followed up for 18-42 months (average 28.22 ± 7.48 months). The total effective rate of postoperative epilepsy control was 87.0%. Engel grade Ⅰ in 8 cases (34.8%); Ⅱ grade in 5 cases (21.7%); Ⅲ grade in 7 cases (30.4%); Ⅳ grade in 3 cases (13.0%). Conclusions Magnetic resonance diffusion tensor fiber tracing technique can reconstruct pyramidal tract and microscopic navigation technique. Precise localization of lesions, epileptic foci and real-time guided surgery can improve the curative effect and reduce postoperative function Missing.